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TRAVELER(S) NAMES: ________________________________________________________________
DEPARTURE DATE: __________________________________________________________________
MODEL REQUESTED:_________________________________________________________________
CARDHOLDER'S NAME: _______________________________________________________________
TYPE OF CARD:
If you plan to split payments between 2 credit cards, we must have a Credit Card Authorization form filled out for each card.
Card Number: _____________________________________________________________________
Expiration. Date: ______________________
Credit Card Verification Value (C.V.V. code): _________________
(This is found on the back of your card and is a three digit code, usually where your signature is on the back.)
BILLING ADDRESS (this address must match the credit card billing address exactly):
STREET: ____________________________________________________________________________
CITY, STATE & ZIP: ___________________________________________________________________
TEL/ FAX/ E-MAIL: ____________________________________________________________________
I verify that all information is correctly provided, and that I, the undersigned, am the card holder of the
above credit card. I further verify that the signature below is my signature as indicated on the reverse of the above indicated card. I hereby authorize Motorhome Rentals World Wide to charge my indicated
credit card, without an imprint for the amounts of:
US DOLLARS (FIGURES ONLY) $______________________________________________________
US DOLLARS (WORDS ONLY)________________________________________________________
plus, any cancellation penalties as imposed by Motorhome Rentals World Wide on this reservation.
I understand that Motorhome Rentals World Wide still reserves the right to request the front and back
copy of my card, and/or of my driver's license should further verification and authenticity of the cardholder be required.
Payments received for the rental booked above by the stated credit card constitutes acceptance of
reservation request by travelers indicated above. Upon receipt of this signed and dated form by Motorhome Rentals World Wide, participants on this reservation are subject to: (1) the General Terms & Conditions of a Motorhome Rentals World Wide reservation, or (2) Specific Terms & Conditions that
are found in our brochure. Failure to have this form, properly filled out and returned to Motorhome Rentals World Wide will result in documents being with held.
Reservation participants also agree not to request any charge backs on the credit card until any
disputed matters are resolved with Motorhome Rentals World Wide. No charge backs will be made until disputed matters are also resolved with the travel agent that has undertaken this booking.
CARDHOLDER'S
SIGNATURE: ____________________________________________________________
DATE: _______________________________________________________
Office Use Only:
INV #: _____________________
APP #: ____________________
DATE: _____________________
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