ACH Form

ACH Authorization Form

Please Fax this to (617) 701-1750 or scan it as a PDF FILE ONLY to
This form must be FULLY completed before tickets can be issued.
To: Alanita Travel®, 87 Common Street, Watertown, MA 02472
Ph: (617)923-4810    Fax No:(617) 701-1750


By signing this form you gave us permission to debit your account for the amount indicated on or after the indicated date. This is permission for a single transaction only, and does not provide authorization for any additional unrelated debits or credits to your account.

**Please check your itinerary for name spellings. We do not use this page for spelling corrections***

Total number of passengers:
Lead Passenger:

Last name / First name as in the passport:
Date of Birth: Gender:

Passenger India phone# :
Passenger Email:

I, (Account holder) authorize Alanita Travel®

to charge my bank account indicated for $ (amount) on or after (date)
,and request Alanita Travel® to issue the tickets below. I am aware that the conditions of my
airline ticket are not mentioned here and that these conditions are stated in my itinerary.I am
responsible for all the conditions of the tickets I am authorizing to be issued.

Billing Address:     Add:
State: Zip Code:

Account Type:
Name on Account:
Bank Name:
Account Number:

Bank Routing# (normally on left side of check):

Signature here: X_____________________________ Date:____________________