CREDIT CARD PAYMENT FORM
I, _____________________________________, hereby authorize R Francis Travel Pro to charge the
amount specified below to my credit card. I have reviewed and understand the refund and cancellation
policies described below. ALL INFORMATION WILL REMAIN STRICTLY CONFIDENTIAL.
Lead Passenger Name: ______________________ Confirmation #: _______________________
CREDIT CARD: _____Visa _____MasterCard _____Discover _____Diner's _____American Express
_____Sign & Travel/Extended Payment Information
CREDIT CARD NUMBER: ______________________________________ Expires: __________________
*Very Important: Include the three (3) or four (4) digit code on credit card ___________________
CREDIT CARD NAME: ___________________________________________________________________
(Exactly as Imprinted on Credit Card)
CREDIT HOLDER'S ADDRESS: (Required for Processing)
Street: __________________________ City: ____________________ State: _____ Zip: __________
Home Phone: ___________________________ Business Phone: _______________________________
Cell Phone: ____________________________________ Fax: __________________________________
E-mail Address: ________________________________________________________________________
Authorized Sale Amount $__________ Authorized Deposit Amount $__________ Insurance __Yes __No
Cardholder's Signature: __________________________________________ Date: _____________________
REVISIONS (except for simple addition of services): Minimum deposit payable at the time of booking
plus the costs of trip cancellation/interruption insurance (optional). Balance due 45 days prior to
travel. Many services are non-refundable once paid and/or documents have been processed if not
covered by trip cancellation/interruption insurance. Costs and reasons vary according to policy. See
your travel consultant for further details.
CANCELLATIONS: $100 per booking once under deposit and $250 per booking once full payment has
been received and/or documents have been processed. Cancellation received within 2 weeks of
departure are subject to a penalty of $300 per person as well as any additional fees imposed at the
discretion of the suppliers.
REFUNDS: Refund requests (if applicable) must be received in writing within 45 to 60 days (pending on the Vendor Policy) prior to the date of travel. Please allow 6-8 weeks for processing and include any unused documents with correspondence.
CONTACT REBECCA FRANCIS PERSONALLY AT 202-726-2684 IF YOU HAVE ANY QUESTIONS.
FAX FORM & CREDIT CARD (FRONT AND BACK) AND A PICTURE ID TO:
REBECCA FRANCIS TRAVEL PRO
OR MAIL COMPLETED FORM AND A PICTURE ID TO:
R Francis Travel Pro
4625 13th Street, NW, #304
Washington, DC 20011