Riya Travels & Tours INC

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Credit Card Authorization Form

Check Payment Form

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Credit Card Authorization Form In Word Format

Credit Card Authorization Form In PDF Format

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Online Credit Card Authorization Form

800 W. AIRPORT FREEWAY, SUITE # 620 IRVING, TX 75062, PH: 972 - 258 – 0103, FAX: 972 – 258 – 0406

RIYA TRAVEL & TOURS, INC. CREDIT CARD AUTHORIZATION FORM

In lieu of my credit card imprint, I hereby authorize, Riya Travel & Tours, Inc. to charge my VI / MC / DS / AX / DC (credit / debit card) in the amount as mentioned below for payment of transportation for myself and/or other passengers. Details are as given below:

Card Holder Name as on card

Credit / Debit Card Number

Credit / Debit Card Expiry Date

Amount to be paid

Name of passenger other than card holder

Billing Address

Work Phone
Home Phone
Cell Phone
Email ID

Driving License Number

State

** NOTE **: Identification is required. Please provide a photocopy of the Credit Card (front & back side) and the Drivers License of the card holder for verification. In case of Third Party Payment we would request you to ensure that all the documents reach us within 48 hours from the time of the transaction. In case we do not hear from from you within 48 hours, your booking will be auto-cancelled and a cancellation fee (non-refundable) will be deducted from your card.

By signing below, I acknowledge the charges described herein, and undertake to make payment in full when billed or in extended payment, in accordance with the standard policy of the credit card company, which issued the card, I also acknowledge that there will be a service charge and penalty in case I cancel or change the date of travel after issuance of the ticket(s) as per the respective Airline fare rules, which are clearly explained to the passenger/card holder prior to issuance for the ticket(s).

Date

Online Check Payment Form

800 W. AIRPORT FREEWAY, SUITE # 620 IRVING, TX 75062, PH: 972 - 258 – 0103, FAX: 972 – 258 – 0406

RIYA TRAVEL & TOURS. INC. CHECK PAYMENT FORM

Date

I authorize RIYA TRAVEL & TOURS.INC to automatically debit the following checking Account:

Checking Account

Routing

Amount

PNR

Passenger Name
Email ID

The copy of the check is attached for your reference. I understand that this signed form is my authorization of this transaction.

Name of Travel Agent

International Office:India | Saudi Arabia

*Taxes/Fees & Restrictions: Air-only and air-inclusive package prices do not include certain government imposed taxes, charges, and fees applicable in addition to penalties, including a September 11th Security Fee of up to $10. Air only prices are roundtrip and per person from select cities. Seats are limited and may not be available on all flights. Blackout dates, travel date restrictions, and advance purchase requirements may apply. Change fees of up to $200 may be charged, and some fares may be non-refundable. Package, hotel, rail & some tour prices are per person, based on 2 adults travelling together. Cruise & sailing prices are per person, based on double occupancy, and cruise only. Supplements vary by cruise line. Where applicable, all savings and free nights are included in all prices.