payment-reservation – Govacations

Reservation Payment

information

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Cardholder Name

Card Number

CVV

Expiration Date

Amount

Check the box

I authorize the above named business to charge the credit card indicated in this authorization form according to the terms outlined above. This payment authorization is for the goods/services described above, for the amount indicated above only, and is valid for one (1) time use only. I certify that I am an authorized user of this credit card and that I will not dispute the payment with my credit card company; so long as the transaction corresponds to the terms indicated in this form.

Reservation Payment

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