Who is your Travel Agent?
Your Confirmation Number:
Please use your confirmation number,
the invoice number.
Your Name(s) *:
Your Email *:
Is this a Honeymoon Registry Gift?
If so, please provide the couple's name(s):
Credit Card Type *:
Credit Card Type
Payment Type *:
Other OR Final Payment
Honeymoon Registry Gift
Travel 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 will apply and unless otherwise noted if your trip is within 75 days it is 100% non-refundable. Air is non-refundable as soon as ticketed and subject to individual airline penalties, 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. Your signed charge authorization is a binding agreement for charging your card, and as such you waive any right to a chargeback in the case of trip delays, changes, or cancellations for any cause (excepting fraud), including a force majeure event, and you agree to refund policies and procedures as outlined in the terms and conditions of the suppliers operating components of your trip. In the event that you attempt without our authorization to chargeback, reverse, or recollect a trip payment already made, we reserve the right to collect all additional costs, fees, and expenses associated with such chargeback, reversal, or recollection including, without limitation, attorney fees. Submitting information via this reservation form does not automatically confirm your reservation, or charge your credit card. Your Certified Travel Specialist will process payment & email you a confirmation invoice within 24hrs. It is your responsibility to review the invoice upon receipt to ensure 100% accuracy. Please check thoroughly for any discrepancies or errors. Horizon Escapes LLC. Is NOT responsible for errors, or any fees associated with necessary changes after 24hrs of receipt.
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)*