Your Confirmation Number:
Please use your confirmation number found on your invoice.
Phone Number :
Credit Card Type
Credit Card Type
Other OR Final Payment
Honeymoon Registry Gift
By checking no, you agree with this statement: I understand that without insurance, there are no refunds for any reason. Travel Insurance protects your vacation investment in the event that your plans change due to weather, natural disaster, financial default of the travel supplier, military deployments, medical needs, need to work, etc. Insurance must be purchased at the time of deposit to maximize coverage and benefits. To read more about insurance, please visit this link: https://goo.gl/yyMrhz or email with questions: firstname.lastname@example.org
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. 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.
Electronic Signature: (Sign with mouse or touch)