Payment Authorization | BlackGirlWorldTravel

Payment Authorization Form

Today's Date (e.g. March 4th, 2025 or 03/04/2025)

First name

Last name

Phone

What are your travel dates? (e.g. 9/16/25 - 9/20-2025)

Your departure airport (Airport/Location you are traveling out of )

Your Destination Airport (Airport/Location you are traveling to. e.g Cancun or CUN is the airport code)

Your departure airport (This is the airport you are flying out of when you leave your vacation/trip)

Your arrival location/airport (This is the airport/location of your final destination once you return home)

Known Traveller Number (Optional to input). Put N/A if it does not apply.

Airline Frequent Flyer Number (Optional to input) Put N/A if it does not apply.

Travel insurance is optional but highly recommended. Travel insurance must be paid in full and added to the authorized amount we charge your card today if you are electing to add it on.

Option 1 - Provides a Travel Credit if you file a claim for a covered reason

Option 2 - Provides a refund to the original form of payment if you file a claim for a covered reason

I would like to decline travel insurance from Black Girl World Traveller LLC.

I acknowledge that Black Girl World Traveller LLC has offered me travel insurance. Please sign below.

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Upload a copy of your non-expired ID. If you are traveling internationally, you must upload a clear copy of your passport instead of your ID. Note: Your passport must expire 6 months after your intended return date, if you are traveling internationally.

What services are you authorizing payment for? Note: Payment authorization on your credit card statement will come from travel vendor (e.g. Apple Vacations, Delta Vacations, Funjet Vacations, etc. )

List the name of the hotel you wish to stay in and authorize payment for. Put N/A if it does not apply.

If your package includes a flight, what seating class would you prefer (basic economy, economy, business, first) If your package does not include a flight, please put N/A.

If your package includes flight, list your seat preferences in order (e.g. window, aisle, middle) If you have a strong objection to a particular seat option please list below as well. If you are not booking a flight in your package, please put N/A.

What type of card are you using? (Visa, Mastercard, Discover, AMEX, Travel credit etc.)

What is your credit card number. Format 0000-0000-0000-0000

What is your card CV number/ security code? (These are the 3 digits on the back on the card or 4 digits on the front if paying with an AMEX card)

What is your card expiration month and year (e.g. 10/2028)

What is your full billing address associated with the card above. (e.g. 1234 Street, Philadelphia, PA 19145)

How much do you authorize Black Girl World Traveller LLC and/or vendors to charge your card? Note: If you are purchasing travel insurance you must add the cost to your total. Input below must be a #. Note: Payments may take up to 72 hours to process.

Do you wish to do a payment plan? If so, put specific dates and amounts you authorize Black Girl World Traveller LLC and/or vendors to charge (e.g. 10/2/2025 - $500 $11/1/2025 -$700, etc). If you want to pay for your trip in full, put N/A.

I authorize Black Girl World Traveller LLC and/or vendors to charge my credit card according to the amounts listed above. If I desire to change my authorized payment date(s), I will contact Black Girl World Traveller within 48 hours of the scheduled day

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I acknowledge that I have read and agree to the policies of booking with Black Girl World Traveller LLC. Full policy can be found here: https://www.blackgirlworldtraveller.com/policies or under the "Terms" section on blackgirlworldtraveller.com

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Optional: Share any additional details that will help in the planning of your trip!