I, _____________________________________________________________________________ (Name exactly as shown on my credit card) Hereby authorizes Just Vacations, Inc. to charge my credit card Type of card(VI, MC, AX, DS) ____________ Number: ____________________________________________________________________ Expiration Date: _________________ Security Code: _______________ For the Amount of: _______________________________________ In Payment of Travel Arrangements for Myself and/or _____________ _______________________________________________________________________________ (Print Passengers Names) My Billing Address is: _____________________________________________________ _____________________________________________________ Phone Number is : (Home) ____________________ (Work) __________________
Signature: __________________________________________________________________ Print Name: ________________________________________________________________ Date: ___________________________________ Request a DocuSign electronic version by clicking the top button or You may print this page and return by fax: 626-593-9303