Credit Card Authorization – Samantha Townsley OW Credit Card Authorization Name As It Appears on Your Card* First Middle Last Suffix Billing Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Credit Card Type*VisaMastercardDiscoverAmerican ExpressCredit Card Number**Please note that you will be contacted via the phone number you provide below to request the card's CVV in compliance of PCI standards.Expiration Date* Date Format: MM slash DD slash YYYY Consent to One Time Charge I hereby authorize Owlways Wandering to charge my credit card or bank account listed above one time only.By checking this option, you authorize us to make a one-time charge to your credit card or bank account listed above. This authorization is for a single transaction only, as per quote/agreed rate provided, and does not permit any other unrelated charges or credits to your account.Consent to Multiple Charges I hereby authorize Owlways Wandering to charge my credit card or bank account listed above as agreed.By checking this box, you authorize us to schedule the remaining charges for your vacation to your credit card or bank account at the specified date and times they are due. You will be charged the amount(s) indicated on your invoice details. A receipt for each payment will be provided to you and the charge will appear on your credit card or bank statement. You agree that prior notification of the charge is a courtesy, but is not required unless the date or amount changes, in which case you will receive notice from us at least 10 days before the payment is collected. Date(s) and amount(s) are as agreed.Please read and check both of the following:* I acknowledge that this authorization will remain valid until all charges are collected.I agree to inform the merchant in writing of any changes to my account information or to terminate this authorization at least 7 business days before the next scheduled charge is due. If the payment date falls on a weekend or holiday, I understand that the transaction may be processed on the next business day. * I hereby certify that I am the holder of the credit card and bank account detailed above and will not dispute the payments with my bank or credit card issuer, provided the transactions comply with the terms specified in this authorization form.SignatureCAPTCHA
