4lowfare.com®

CREDIT CARD AUTHORIZATION
Airline:

Reservation Code:

Lead Passenger's Last Name:

Total Fare:

Courier Service:

Total Amount:

(If a courier service is not chosen, 4LOWFARE.COM will choose appropriate service and add charges to Total Amount)
Type:

Number:

Expires (MM/YY):

Card ID:
(Please check your itinerary for cards allowed for your booking. ATM/Debit Cards are not allowed.)
Issuing Bank:

Bank Telephone:
Your Name as on Credit Card:
Billing Address (Required):
(must match the address where you receive your credit card statement. This address will be used to verify the credit card.)
Street:
Addr2:
City/St:
Zip: Tel:
Shipping Address (Optional):
(enter if you wish to receive tickets at another address or if the Billing Address is a PO Box address.  British Air tickets can be sent only to Billing Address)
Street:
Addr2:
City/St:
Zip: Tel:
In lieu of presenting my card physically, I am completing this form and hereby confirm that:
1. I am the authorized signatory for the card for which details are provided above.
2. I have received complete details of the travel services that I am purchasing from 4LOWFARE.COM Inc. including cancellation/ refund/ change policies and penalties for the said travel services. I have read and agree with the Terms of Sale provided on their web site.
3. I hereby authorize 4LOWFARE.COM Inc. and/or its suppliers to charge the above-mentioned credit card for the purchases of travel services referenced herein.
4. I am aware that upon this authorization, I will be subject to the applicable cancellation/refund/change policies.
5. I am aware that 4LOWFARE.COM Inc. will send travel documents to me when they are received at the agency from their suppliers.
6. I agree to pay the amount authorized above to the credit card issuer as per my credit card agreement.
7. I understand that if the credit card gets declined twice due to any reasons, there will be a separate charge of $50 irrespective to the purchase transaction.
Signature of Card Holder:

Dated:

Instructions for filling up the form:
1. Fill the form online and print it.
2. Check the cards allowed under Payment Options of your itinerary.
3. REMEMBER TO SIGN THE AUTHORIZATION FORM.
4. REMEMBER TO COMPLETE THE ADDRESS INFORMATION.
5. Fax the completed form to 4LOWFARE.COM at 916-984-1125 along with verification documents (front and back of credit card and government issued photo-id with signatures e.g. Driver License or Passport).

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