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Credit Card Authorization Form

Please Select Tour Departure Date

Full name of credit card holder

I, as the guest entered above, have authorized ElderTreks/Passages Exotic Expeditions Ltd. to charge the following: (select below) on my form of payment provded.

In the amount of:

I understand that ElderTreks will process only such charges on the credit card(s) as the card

issuing company allows. ElderTreks has USD as well as CAD bank accounts and is not responsible for foreign transaction fees charged on your card.

I further declare that the signature appearing below is identical with the signature appearing on

my credit card (s).

Select credit card type

Visa

Mastercard

Enter last 6 digits of credit card used

Name on Card

Address of Card Holder

Your Signature

Dted Signed

Note: that the "Submit button" may take a up to a minute as it sends your information to us.

Please click once only and wait for the success message.

1-800-741-7956 North America . 0808-234-1714 United Kingdom . 1-416-588-5000 Worldwide . 1-647-945-8807 Fax

Credit Card Authorization Form

Guaranteed Departures

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