(614) 771-6200
5064 Cemetery Rd. Hilliard, OH 43026
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Credit Card Authorization Form * Required Fields


  
  
    



VI   MC  AX  DS  OTHER 







Passengers Names exactly as appears on Passport* Gender & DOB: (MM/DD/YY)*

Male   Female 


Yes   No 
Passengers Names exactly as appears on Passport* Gender & DOB: (MM/DD/YY)*

Male   Female 


Yes   No 
Passengers Names exactly as appears on Passport* Gender & DOB: (MM/DD/YY)*

Male   Female 


Yes   No 
Passengers Names exactly as appears on Passport* Gender & DOB: (MM/DD/YY)*

Male   Female 


Yes   No 
Passengers Names exactly as appears on Passport* Gender & DOB: (MM/DD/YY)*

Male   Female 


Yes   No 
Passengers Names exactly as appears on Passport* Gender & DOB: (MM/DD/YY)*

Male   Female 


Yes   No 

*Please note that some countries may require a Visa

PLEASE READ CAREFULLY BEFORE SUBMITTING

I give full authorization to Active Travel, and/or other tour provider to charge the above mentioned amount on my credit card and shall not decline, reject or challenge such amount charged on my credit card for the purpose of paying for air, cruise, tour, or other trip components for the passengers identified above. I am aware that some restrictions may apply to the trip purchased by this transaction. By accepting these terms, I am consenting to the supplier's terms and conditions. I have been offered insurance for my travel arrangements.

Yes   No 

Yes   No 

**Please note the following**

Passports must be valid for minimum of 6 months after return travel date

All adult passengers on all domestic flights beginning October 1, 2020 will be required to have a Compliant Driver’s License or State ID

  
Active Travel
5064 Cemetery Road, Hilliard, OH 43026
Tel. (614) 771-6200 E-mail: activetravel@msn.com