MickeyTravels Credit Card Authorization Form

Name on Card: *

Credit Card or Gift Card # *

Security Code or Disney Gift Card Pin: *

Expiration Date *

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

Amount you would like to put towards your vacation: *

By signing here, I authorize Shannon Loehrlein, my travel planner with MickeyTravels to use the card provided to process my payment(s). * *

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Please be sure to send an email to sloehrlein@mickeytravels.com after submitting a deposit. This will alert me that you are ready to book your vacation and payment is ready to be applied! Thank you! * *

Okay

Shannon Loehrlein MickeyTravels, LLC Authorized Disney Vacation Planner- Diamond Level 812-550-2944 Sloehrlein@mickeytravels.com