Payments – Brock Tours & Travel

CC Authorization & Purchase Agreement

Please fill out all of the required elements of the CC Authorization & Purchase Agreement form for review and payment to proceed with your booking!

Name (Exactly as on card)

Cell Phone

Other Phone

Name of Tour/Cruise

Card Number

CVV Code

EXP on Card

Charge Amount

Payment Date

Billing Address

Address Line 2

City

State

Zip

Reauest Travel Insurance Quote

Yes No

CC Authorization

By checking this box, I give my permission to Brock Tours & Travel, LTD to charge my travel arrangements to the credit card named above.