TravelJoy

Mallory Dumond

Mallory Dumond - Travelmation, LLC

Credit Card Authorization

<html>
  <body>
    <form-template>&#13;
	<fields><field type="text" subtype="text" required="true" label="First name" className="form-control" name="first-name"></field><field type="text" subtype="text" required="true" label="Last name" className="form-control" name="last-name"></field><field type="text" subtype="text" required="true" label="Email" className="form-control" name="email"></field>&#13;
		<field type="text" required="true" label="If making a payment on an existing booking, please include your booking number. If you are paying your first deposit, please put &quot;new booking&quot;&amp;nbsp;" name="if-making-a-payment-on-an-existing-booking-please-include-your-booking-number-if-you-are-paying-your-first-deposit-please-put-new-booking-" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Enter the amount to authorize:" name="amount" subtype="text" className="form-control"/>&#13;
		<field type="paragraph" subtype="p" label="By authorizing my payment, I agree that I am hiring Mallory Dumond - an agent with Travelmation to plan my trip and have read, understand, and agree to all applicable terms, conditions, supplier and agency cancellation and refund policies, and entry requirements for the trip that I am booking. (This includes the terms and conditions located at www.mallorytravels.net/termsandconditions)"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>

By signing below, I authorize Mallory Dumond - Travelmation, LLC to charge the credit card provided herein.

Click to sign