Payment

    General Information
    Payment Type
    Credit Card Information

    Note: For security reasons, we ask that you split your card number into 2 separate parts.

    ACH Debit Information

    Note: For security reasons, we as that you split your account number into 2 separate parts.

    ACH Credit Information (for issuing refunds)

    Note: For security reasons, we as that you split your account number into 2 separate parts.

    Authorization

    By submitting this form, I authorize the above-named business to charge the credit card indicated in this authorization form according to the terms outlined above. 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.

    I hereby authorize Mission Nation Travel, hereinafter called MNT to initiate ACH debit entries from the financial institution named above from my Bank Account

    I hereby authorize Misson Nation Travel, to initiate credit entries to my Checking or Savings account indicated at the financial institution listed above, and to issue credit payments to such account. I acknowledge that the origination of ACH transactions to my account must comply with the provisions of U.S. Law. This authorization is to remain in full force and effect until Mission Nation Travel has received written notification from me of its termination in such manner as to afford Mission Nation Travel and your bank a reasonable opportunity to act on it.