Payments - Brock Tours and Travel

CC Authorization & Purchase Agreement

Please complete all of the required elements of the CC Authorization form for review and payment to proceed with your booking or purchase.

Is this a group booking?

No Yes

Tour or Group Name

Confirmation No

Expected Date of Travel

Cell Phone

Other Phone

Name (Exactly as on card)

Billing Address

City

State

Zip

CC Number

CVV

EXP

Charge Amount

Special Requests/Comments

Card Holder Authorization

By checking this box, I (the named cardholder), give my permission to Brock Tours & Travel to charge my travel arrangements or purchase to the credit card named above.