<% if request.form("btnsubmit")<>"" then ' agent=request.form("agent") ' cardholdername=request.form("cardholdername") ' cardno=request.form("cardno") ' expiration=request.form("expiration") ' billingaddress=request.form("billingaddress") ' home=request.form("home") ' office=request.form("office") ' cell=request.form("cell") ' email=request.form("email") ' passenger1=request.form("passenger1") ' passenger2=request.form("passenger2") ' passenger3=request.form("passenger3") ' passenger4=request.form("passenger3") ' route=request.form("route") ' accept=request.form("accept") expiration=request.form("mm")&"/"&request.form("yy") 'response.write(expiration) a1="" a2="" a3="" a4="" a5="" a6="" a7="" a8="" a9="" if not request.form("home")="" then a10="" end if if not request.form("office")="" then b1="" end if b2="" b3="" b4="" if not request.form("passenger2")="" then b5="" end if if not request.form("passenger3")="" then b6="" end if if not request.form("passenger4")="" then b7="" end if b8="" b9="" b10="" c1="
Credit Card Authorization Form

Attn Agent :

"&request.form("agent")&"

Card Holder's Name :

"&request.form("cardholdername")&"

Card No :

"&request.form("cardno")&"

Expiration :(MM/YY)

"&expiration&"

Billing Address For Credit card :

"&request.form("billingaddress")&"

Phone Numbers

Home

"&request.form("home")&"

Office

"&request.form("office")&"

Cell

"&request.form("cell")&"

E-mail :

"&request.form("email")&"

Passengers 1 :

"&request.form("passenger1")&"

Passengers 2 :

"&request.form("passenger2")&"

Passengers 3 :

"&request.form("passenger3")&"

Passengers 4 :

"&request.form("passenger4")&"

Card Type :

"&request.form("cardtype")&"

Payment :

$ "&request.form("payment")&"

Route :

"&request.form("route")&"

" summary_message=a1+a2+a3+a4+a5+a6+a7+a8+a9+a10+b1+b2+b3+b4+b5+b6+b7+b8+b9+b10+c1 'response.write(summary_message) 'response.end on error resume next sch = "http://schemas.microsoft.com/cdo/configuration/" Set cdoConfig = Server.CreateObject("CDO.Configuration") cdoConfig.Fields.Item(sch & "sendusing") = 2 cdoConfig.Fields.Item(sch & "smtpserver") = "localhost" cdoConfig.fields.update Set cdoMessage = Server.CreateObject("CDO.Message") Set cdoMessage.Configuration = cdoConfig cdoMessage.From = request.form("email") 'cdoMessage.To = "sanjay@lowfaretotravel.com;rajnesh.rawat@gingerwebs.com" cdoMessage.To = "sanjay@lowfaretotravel.com" cdoMessage.cc = request.form("email") cdoMessage.bcc = "sales@gingerwebs.com" cdoMessage.Subject = "Credit Card Authorization Form" cdoMessage.HTMLBody = summary_message cdoMessage.Send Set cdoMessage = Nothing Set cdoConfig = Nothing response.redirect ("thanks1.html") 'response.write("") end if %> Low Fare Travels:- Credit Card Authoization Form

 

 
 

 
 

In lieu of my credit card imprint as required by Airline Reporting Corporation Section 8.4, I hereby authorize Lowfare to Travel Inc.
And/or the ticket issuing airline to charge the following amount from my credit card.
 
Click here for printable form  
   
Attn Agent* :

Card Holder's Name* :

Card No* :
Expiration* : (MM/YY)

Month   Year

Billing Address For Credit card* :

Phone Numbers :

 Home

Office

Cell

E-mail* :

   

Passengers* :

1.

2.

 

 

3.

4.

 
Card Type :

American Express
 

VISA
 

Master Card
 

Discover
 

Diners
Payment in ($)* :

Route* :

 

By checking this box , I accept full liability for the charges described herein. Payment in full will be made when billed in accordance with the standard policy of the bank issuing the card. I am aware that these tickets are non refundable and subject to a penalty from charge as specified by my travel agent.

All Credit Card payments must be supported by copies (front and back) of the Credit Card used and a Federal ID such as Driver’s License or Passport.

**Most airline tickets are Electronic Tickets delivered by Email or Fax. **

Note: A cancellation penalty of US$ 275.00 or more applies on cancellation of all tickets.

This form must be completed in full and all information must be true and correct in order for ticket issuance to be complete.
   

 

 

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