Credit Card Form

Vacation in Paris, LLC
10 Wildwood Trail
NEWTON, NJ 07860 USA
1 973 948 3535
Print this form & return it by mail to the address above or
fax to: 1 973 948 2232
CREDIT CARDHOLDER'S AUTHORIZATION

In lieu of my credit card imprint, I __________________________________(print name of cardholder as shown on credit card)

hereby authorize Vacation In Paris, LLC to charge credit card number ______________________________________

with an expiration date of ___ /___ (mm/yy) the amount of $_______________ (specify the amount for this charge in USD)

for payment of myself or _________________________________ (full name of traveler if other than cardholder)

for Vacation In Paris reservation number _________.

My credit card billing address is:

Street: _______________________________ Apt # ________

City ______________________, State/Province _________ Postal Code _____________

Country ___________________________

My phone number is: ________________________________