4lowfare.com®

CHECK PAYMENT AUTHORIZATION
Airline:

Reservation Code:

Lead Passenger's Last Name:

Total Fare:

Courier Service:

Total Amount:

(If a courier service is not chosen, 4LOWFARE.COM will choose appropriate service and add charges to Total Amount)



PLEASE FILL AND PRINT THIS FORM


PLEASE MAKE CHECK PAYABLE TO

4LOWFARE.COM INC.

STAPLE YOUR CHECK IN THIS PLACE

AND MAKE A PHOTOCOPY


FAX THE PHOTOCOPY TO US

Shipping Address (Required): (Note: PO Box Address is not acceptable)
Name: Tel:
Street: City/St: Zip:  
This is to confirm that I am placing a ticket order for the booking referenced in this form and:
1. I am the authorized signatory for the account from which a check has been attached above.
2. I have received complete details of the travel services that I am purchasing from 4LOWFARE.COM Inc. including cancellation/ refund/ change policies and penalties for the said travel services and I agree with the Terms of Sale.
3. I am aware that upon this authorization, I will be subject to the applicable cancellation/refund/change policies.
4. I am aware that 4LOWFARE.COM Inc. will send travel documents to me when they are received at the agency from their suppliers.
5. This fax is my authorization to my bank to pay the above-mentioned amount to 4LOWFARE.COM Inc. (Note: This authorization may be used to obtain funds using an electronic funds transfer/check presentment process for the amount authorized above.)
6. I am aware that if the bank for insufficient funds rejects the above check, I will be liable to the maximum collection fees allowed by the laws of my State of residence and a minimum fees of $25 in addition to the amount authorized above.
Signature of Account Holder:

Dated:

Instructions for filling up the form:
1. Fill the form online and print it. 3. REMEMBER TO SIGN THE AUTHORIZATION FORM AND THE CHECK.
2. Place your check in the space given above. 4. REMEMBER TO COMPLETE THE ADDRESS INFORMATION.
Fax the completed form to 4LOWFARE.COM at 916-984-1125. If you are paying by a business check, cashiers check, brokerage account check or money order, please send the payment by courier/express mail  to the following address:
4LOWFARE.COM INC. (attn: Accounts)
2795 East Bidwell Street $100-198
FOLSOM CA 95630
PH: 916-353-5220		 Click Here to Print This Page