Sophia’s Travel, Division of E&M Travel

4172 Ridgemoor Dr. N, Palm Harbor, FL 34685 | Phone: 727-254-4373 | Email sophia@sophiastravel.com

I, the undersigned (Print Name), Authorize E&M Travel to charge my credit card representing payment for booking number (if available)

Print Name

Booking Number

Include Services:

To charge the amount:

To My:

Credit Card Number:

CVC:

Expiration Date:

Billing Address

City

State/Province

Zip Code

Country

E-mail:

Phone:

I am aware of any cancellation policies and agree not to dispute or attempt of Chargeback any of the above signed for and acknowledged charges.

Fill and Print out this form and fax it back to us at 203-653-5586. Important! Please include clear copy of credit card from both sides and driver's license.

VERY IMPORTANT: Please be advised that your Credit Card statement will show E n M Travel