CREDIT CARD AUTHORIZATION

Dear Group Participant,

In order to authorize Cubanow.org to charge your credit card for the services indicated, please fill out and return this form to our office at the address listed above or via fax with a photocopy of both sides
of your credit card.

Charges can only be made to the actual traveler's credit card - except for spouses and children. In this
case, we also require a copy of the credit card holder's driver's license or photo i.d.

We will consider charges to a non-family member's credit card only if the credit card holder is traveling
at the same time and sends a signed letter specifically requesting the additional charges.

We reserve the right to refuse to accept charges to any credit card not issued to the traveler.

FIRST NAME: ________________________ M.I.: _______ LAST NAME: _________________________
(Credit card holder - this should be as it appears on your credit card)

BILLING ADDRESS: ___________________________________________________________________

DAYTIME PHONE: (_____)____________________ EVENING PHONE: (_____)____________________

FAX: (_____)___________________ E-MAIL: ______________________________________________

TYPE OF CREDIT CARD: ________VISA ________MASTERCARD

ACCOUNT NUMBER: _____________________________________ EXP. DATE: _______/_______

SIGNATURE: ____________________________________________ DATE: ____________________

AMOUNT AUTHORIZED: $_________________

GROUP NAME:

DATES OF TRAVEL:

Group Programs to Cuba are subject to the following cancellation charges if you cancel for any reason:
In addition to airline cancellation penalties, all cancellations for any reason are subject to a $100 per person cancellation fee. Cancellation from 90 to 60 days before departure will result in forfeiture of 10% of the trip cost per person; from 60 to 31 days 30% and from 30 to 8 days 50%. Cancellation from 7 days up to the time of departure will result in forfeiture of the entire cost of the trip.
Trip cancellation and baggage insurance is available at www.travelinsure.com.
Above charges do not include cancellation charges imposed by the airlines for any connecting flights to/from your point of departure to Cuba. Nor do they include air tickets from Canadian or other cities to Havana on a non-refundable basis. Cubanow.org accepts no responsibility for the issuance or denial of licenses by the Office of Foreign Assets Control nor for the issuance or denial of visas by Cuba.