pre-authorized payment form

This form is ONLY for Clients who have a Pre-Authorized Method of Payment with MaxLife Travel Agency.

If You have NOT provided a Pre-Authorized Method of Payment, Please use this form instead: Standard Payment Authorization Form

Refer to the BOOKING CONFIRMATION for the Final Payment Due Date and Balance.

Contact your Travel Agent with any Questions or Concerns.

*Name(s) on Reservation

*Booking Reference# OR Group Name (if applicable)

*How Much Are You Paying Today? [Type "ALL" If Paying Total Final Balance]

*Do You want to ALSO Setup an Automatic Payment for the Remaining Balance on the Final Payment Due Date?

Additional Instructions (optional)

Please charge my credit card for the amount indicated above for the referenced reservation. I understand all of the terms and conditions regarding this booking including cancellation policies, applicable penalties, and the availability of travel insurance.

If you are using a debit card with a daily spending limit, it is your responsibility to contact your bank to give them permission to authorize the transaction. If they require the name of the vendor and you are unsure as to who that is, please contact your Travel Agent at MaxLife Travel.

MaxLife Travel

(770)744-2977

Advisor@MaxLifeTravel.com