Credit Card Authorization Form

Name on Card*
Card Number*
Card Brand*
Expiration Date:MM/YR*
CRV*
Street Address:
City:
State:
Zip Code:*
Country
Phone:
Email Address:
Reservation Number (optional)
Payment Amount
By completing this form, I authorize Dream Vacations Dana Apple to charge the credit card provided for travel services rendered. I understand the charges reflected on my statement will show the supplier name and/or Apple Vacations. I am an authorized user on this credit card account. My consent on this form constitutes an electronic signature.
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