Make A Payment

PAYMENT AUTHORIZATION

Thank you for choosing Black Rose Travels for your upcoming vacation. We look forward to helping you plan your vacation. For your convenience, you may use this form to authorize a payment on your vacation.

PLEASE NOTE:

Completing this form does not process your payment immediately. Once submitted, it simply authorizes our team to process a payment on your behalf. If you do not see the funds taken out of your account immediately, please allow us some time to process. You will receive an email confirmation once your payment is processed.

1.Payments are only processed during normal business hours (M-F 9am - 5pm EST).

2.Payments received after hours may not be processed until the next business day.

3.If any of the following fields are left blank we may not be able to process your payment and your reservation may cancel.

4.If your reservation is DUE on the date you are submitting payment, please ensure you complete this form before close of normal business hours as stated above.

If you have any questions, please contact us at blackroseglobaltravel@gmail.com.

Insert and format text, links, and images here.

Reservation Number

Destination

Name

First Name

Last Name

Phone

(###)

###

####

How many cards will you use to make this transaction?

You are able to use up to 2 cards to complete a transaction for one person

1 Card

2 Cards

Authorization Amount

Cardholder Name

Card Type

Card Number

Expiration Date

Verification Code

Three numbers on the back or four numbers on the front if AMEX.

Billing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

How should we apply this payment?

1.You will select "apply to personal balance" if you are splitting the total on your reservation with others. 2.You will select "apply to the total balance" if you would like this payment to be deducted from the full balance.

Apply to my personal balance on the reservation

Apply to the total balance on the reservation.

Waiver of Liability

By signing and submitting your signature below, you agree to the outlined terms & conditions for all members of your travel party.* This agreement releases BlackRoseGlobal, LLC from all liability relating to injuries, illness or quarantine that may occur during domestic and/or international travel. By signing this agreement, I, and all travel companions, agree to hold BlackRoseGlobal, LLC entirely free from any liability, including financial responsibility, for injuries, illness or quarantine, regardless whether injuries or illness are caused by negligence. By submitting my signature, I acknowledge all inherent risks involved in domestic and/or international travel, for myself and my travel party.

Print Full Name

Today's Date

YYYY

I authorize Black Rose Global to charge my credit card in the amount designated above. By choosing "I authorize" in the dropdown below and submitting this form, you certify that: 1.You are the cardholder OR have explicit permission to utilize the card information above. 2. You authorize Black Rose Global and/or their suppliers to charge the listed amount to the card. 3. You understand this authorized payment will be manually applied by Black Rose Global directly to your reservation with the supplier used to book your vacation. A receipt will be emailed upon payment application to your reservation. If there are any issues, Black Rose Global will contact you! Please note, you will not see a charge by Black Rose Global, but you will see a charge from the supplier directly. Payment may take 3-5 business days to fully process and reflect on your statement.*

Make a Payment

PAYMENT AUTHORIZATION

Black Rose Global Travel