Online CC Payment – STG Travel

One Time Credit Card Payment Authorization Form

Please complete this form to authorize STG Travel Inc to make a one time debit to your credit card listed below.

By completing this form you give us permission to debit your account for the amount indicated (including a non-refundable 5% CC Surcharge Fee) on or after the indicated date. This is permission for a single transaction only, and does not provide authorization for any additional unrelated debits or credits to your account.

Credit Card Payment

Agent you are working with

Description of goods/services

Credit Card *

Authorization

By checking this box I authorize my credit card to be charged by STG Travel, Inc. This payment authorization is for the goods/services described above, for the amount indicated above only, and is valid for one time use only. I certify that I am an authorized user of this credit card and that I will not dispute the payment with my credit card company; so long as the transaction corresponds to the terms indicated in this form.

Billing Info

Full Name *

First

Last Name *

Last

Address *

Address

Street Address

Building/Suite/Apartment #

City

State/Province

Zip/Postal

Country

Number