Contact Information
Your Confirmation Number:
Please use your confirmation number found on your invoice.
CCV Number
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Travel Dates
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Your Name(s)
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:
Your Email
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:
Is this a Honeymoon Registry Gift?
Yes
No
If so, please provide the couple's name(s):
Credit Card Type
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:
Credit Card Type
American Express
Discover
MasterCard
Visa
Payment Type
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:
Payment Type
Deposit
Other OR Final Payment
Honeymoon Registry Gift
Total Amount to Charge
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Travel Protection
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:
ACCEPT Protection.
DECLINE Protection.
I understand that I CANNOT purchase the cancel for any reason insurance once my deposit is paid.
Additional Comments :
By submitting, you certify that you are the cardholder and are authorizing the travel agency or its chosen Tour Operator/Supplier/Cruise Line to charge the listed amount to the credit card. You certify that you have verified that all information contained in the confirmation you received is accurate. You also certify you have read the Terms & Conditions and the appropriate Travel Protection Plan details. Cancellation penalties may apply. Insurance is not refundable.
This charge will be manually applied by the agency to your reservation. If there are any issues, an agent will get back to you. Please note that you may not see a charge from the travel agency on your credit card statement; the charge will come from our supplier and/or the airline directly. Payment may take 3-5 business days to fully process and be reflected on your statement.
I authorize the travel agency to use the above information to charge my credit card the stated amount. Completion of this form and the initialing of this box signifies acceptance in lieu of my signature.
I acknowledge that I am aware of any risks and alerts that have been issued to the country I am traveling to. It is my responsibility to address any concerns or review any updates as necessary.*Please be sure to review the list of current travel alerts here-->https://travel.state.gov/content/travel/en/traveladvisories/traveladvisories.html and advise of any concerns before deposit. We always recommend travel insurance, especially when leaving the country. The United States Government requires a valid passport for re-entry into the United States regardless of the departure date from any other country. Traveling to any country other than the United States of America regardless of age we are aware that we must possess a legal Passport, Visas and/or legal documents that may be required by that country. We understand that the passport must be valid for at least six months after our return date of travel. Please visit www.travel.state.gov for specific rules. Children under the age of 18 not traveling with both natural parents require a notarized letter signed by the absent parent(s) giving permission to the traveling parent or authorized adult to take the child out of the United States. This letter must contain the travel dates and the name and address of where the child will be staying. It is our (the passenger/s) sole responsibility to have the proper legal documents for travel in our possession at all times during travel and in no way will we hold Mode Travel or it's agents be liable for misplacement or destruction of our official documents for travel. Names must match the required government issued ID exactly. I will be responsible for all cancellation penalties or loss of monies that may incur for our failure to produce the proper legal documentation. I understand that it is my responsibilty to check with the airline for any updates to schedule changes 24-48 hours prior to departure. This can be checked online while checking in for your flight as well. Cruise Passengers - Cruise lines have restrictions on sailing when pregnant. Women who have entered the 24th week at the time of sailing may be denied boarding. I understand that by proceeding, this account will be charged today (pending approval) and full penalties will apply as described in the rules of the reservation. Airline tickets are completely nonrefundable, with changes subject to significant airline penalties. Hotel packages and deposits are also nonrefundable unless otherwise noted. I have checked the spelling of the names as they appear on government issued ID (passport if itinerary requires). I have checked the itinerary dates, cities, and airline. IMPORTANT: If this is a check or debit card, please check with your bank that you are not exceeding a daily spending limit on the card. Most banks have a daily limit regardless of amount of funds in the account, and exceeding this limit will cause a decline and delay in your payment. By submitting payment, you certify that you are the card holder authorizing Mode Travel Agency Inc. or one of its affiliates to charge your card in the amount submitted.
By checking the box below and adding your signature, you indicate that the above amount is correct, you authorize the travel agency to charge your credit card for the specified amount, and you agree to the terms and conditions.
I Agree
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×
Ok
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