Date Change Authorization and Charge Form

This form must be FULLY completed before date changes can be made.

TO : Alanita Travel 87 Common Street, Watertown, MA - 02472 

Ph: (617)923-4810 Fax : (617)701-1750  

I, (Credit card holder's Name) request Alanita Travel to make the
 following date changes noted below and authorize Alanita Travel to charge the amount listed below.

Names of Passengers:

 

Last Name / First Name

 

Last Name / First Name

 

1.

2.

3.

4.

If passengers are not flying on same dates as each other, please fill out separate forms for each passenger.

 

Airline

 

Departure Date changed From :

MM DDYY

To:

MM DDYY

Return Date changed From :

MM DDYY

To:

MM DDYY

 

 

 

 

Cardholder Name(s)

 Email Address

Cardholder Phone (W) 

(H)

 

Credit Card Type

(No Debit Cards or Corporate cards)
Discover Cards not accepted on Emirates,  Swiss Airlines & Air India

 

Credit Card Number

  Expiry Date

 

Total amount to be charged

4.5% will be added for CC service fee

 

Billing Address 

Add.  

City  State  ZipCode 

 

Issuing Bank

  Bank Customer Service Tel#

 

Please fax a copy of your credit card front and back *lighten copy please*
Yours truly,

 

 X_____________________                       Date:____________________

PLEASE CHECK WITH YOUR AGENT TO SEE IF YOUR TICKETS NEED TO BE RETURNED TO ALANITA TRAVEL