Travel Tech Inc

Refund and Cancellation Authorization Form

Travel Tech Inc

Form :

Airline :

PNR/Confirmation Code :

Email id :

Passenger 1

LAST NAME :

FIRST NAME :

TICKET NUMBER :

Passenger 2

LAST NAME :

FIRST NAME :

TICKET NUMBER :

Passenger 3

LAST NAME :

FIRST NAME :

TICKET NUMBER :

Passenger 4

LAST NAME :

FIRST NAME :

TICKET NUMBER :

Passenger 5

LAST NAME :

FIRST NAME :

TICKET NUMBER :

CARDHOLDER'PHONE :

PASSENGER'S PHONE :

TICKET ISSUED DATE :

Total Paid fot the Ticket :

Mode of Payment :

Reason for Cancelling :

I agree and authorize Travel Tech to charge my credit/debit card on behalf of its associated suppliers for the charges detailed above. For Airline tickets billing, your total tariff may be split billed between the merchant ( Travel Tech ), the Airline(s) and/or associated suppliers equaling the amount being authorized for the purchase. Each passenger(s) mai be charged separately and Total amount is inclusive for all the passenger(s).

Signature of cardholder:

Date: