Testing Form Page | MA World Travel

This form authorizes your MA World Travel agent to process payments and credit card holds for your vacation on your behalf. Please read the form carefully and complete all information. IMPORTANT NOTE: Please do NOT include your entire credit card number on this form. You will provide that to your agent by phone or in person.

MA World Travel Agent*

Credit Card Type*

Last 4 digits of credit card number*

Expiration Date*

Credit Card Expiration Date

Cardholder Name (as it appears on the card)*

Billing Address*

Street Address Address Line 2 City State ZIP Code

Phone Number*

Email*

I hereby authorize my MA World Travel agent to use my credit card listed above for the following purpose (check all that apply):

Vacation Deposit
Final payment on my vacation
Credit card holds for dining and other reservations
Prepayment of any dining or other reservations
Travel insurance payment
Any other components of my vacation not listed above

Deposit Amount*

I certify that I am the cardholder above.*

Yes
No

I authorize MA World Travel to process payments on my behalf using my credit card.*

Yes
No

I certify that I will authorize specific charge amounts by sending an email to my MA World Travel agent prior to payment.*

Yes
No

Signature*

By signing my first and last name in the box, I certify that I agree to conduct this transaction by electronic means. I also certify that I am responsible for payment of all charges listed above and will hold MA World Travel and its agents harmless with respect to those payments, and any other payments MA World Travel processes on my behalf.

Phone

This field is for validation purposes and should be left unchanged.

Credit Authorization