Credit Card Authorization 8/07 

FAX to 712 258 1776 or mail to CycleItalia PO BOX 1386 Sioux City, IA  51103

 

I authorize CycleItalia, LLC to charge the account listed below for the vacation(s) or merchandise indicated. 

 

______________________________________________________________

Tour name (or merchandise description)

 

_____________________________________________________________

Signature of card holder                                                      Date

 

____________________________________________________________

Name as printed on credit card

 

____________________________________________________________

Address

 

____________________________________________________________

City                                                     State                Zip                   Country

 

_____________________________________________________________

Billing address (if different from above):

 

_____________________________________________________________

Phone                                                              email

 

_____________________________________________________________

Number on credit card                                           expiration date

 

Circle:                         VISA                                       MASTERCARD

 

_____________________________________________________________

Amount (US dollars)

 

I further authorize CycleItalia LLC to charge the balance due portion of my vacation on April 15, 2008    YES                 NO

 

Cancellation Policy:  If you must cancel your trip for any reason, your deposit is refunded less a 50% cancellation fee if we are notified in writing prior to April 15, 2008.  Refund (less the cancellation fee) of payments requested after April 15 will be made only if we can fill your space.  CycleItalia reserves the right to cancel any trip at any time prior to departure for any reason and refund of any payment(s) received by CycleItalia shall constitute full settlement.

 

I have read and understand the cancellation policy above_____________________Initial