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CREDIT CARD AUTHORIZATION FORM
In order to process your charge,
please complete the following information along with a photocopy
of both sides of your credit card and return by fax to (813) 907
- 1763 or mail to the address
below.
I, ___________________________________ authorize Caribbean Adventures/World Dive Adventures as an agent to place
travel related charges on my credit card account.
(VI, MC, DIS, AMX)#___________________________________, expiration __/__/___ in the amount of
Total US $ _______________ for all services related to travel on my trip departing __/__/___ (mm/dd/yy)
Confirmation # _______________________. CA Agent name______________
Pricing: Air $________#of tix___ Date due ___/___/___ Deposit $_________Date due___/___/___
Final payment$_______________ Date Due ___/___/___
________________________________________ __________________________________________
Signature Date Full Name as It Appears On the Card
________________________________________ ___________________________________
Billing Address - Daytime Phone
________________________________________ ___________________________________
City, State, Postal Code, Country - Daytime Fax
________________________________________ ___________________________________
E-mail Address - Evening Phone
If you would like us to automatically charge the balance of your trip on your final payment due date, please sign
and date below. We will mail a confirmation of the charge to the address you provide.
_______________________________________________ US$___________________________
Signature, Date - Amount to be charged
I fully understand that all deposits and payments on all Caribbean Adventures/World Dive Adventures are subject
to the policies and conditions as stated on your application form, which I have read and agree to. I also understand
that any refunds paid in accordance with the policies and conditions may only be given with the authorization of
Caribbean Adventures/World Dive Adventures.
Signature _____________________________________________ Date __________________________________
Please Return This Form To:
Caribbean Adventures/World Dive Adventures
2211 Ashley Oaks Circle Ste 215
Wesley Chapel, FL 33543
Toll-Free 1-800-433-DIVE
Local Phone - 813-907-2922 or 813-994-4368 • FAX - 813-907-1763
Web Site: www.worlddive.com - E-mail: diveres@worlddive.com
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