Sign and complete this form to authorize Just So Magical Vacations to make a debit to your credit card listed below. ONLY INCLUDE THE LAST 4 NUMBERS OF YOUR CARD. SCHEDULE A CALL WITH YOUR TRAVEL AGENT TO SUBMIT FULL CARD NUMBER.

By completing this form you give us permission to debit your account for the amount indicated on or after the indicated date. This is permission for a single transaction only and does not provide authorization for any additional unrelated debits or credits to your account.

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Description of goods/services

Amount

Card type

Account ending in (LAST TWO DIGITS ONLY)

Date

YYYY

Signature

I authorize the above named business to charge the credit card indicated in this authorization form according to the terms outlined above. This payment authorization is for the goods/services described above for the amount indicated only and valid for one time use only. I certify that I am an authorized user of this card and I will not dispute the payment with my credit card company.

Your Agent