Who is your Travel Agent?
Kimberly & Jeff Jacoby
Your Confirmation Number:
Please use your confirmation number found on your invoice.
Is this a Honeymoon Registry Gift?
If so, please provide the couple's name(s):
Credit Card Type
Credit Card Type
Other OR Final Payment
Honeymoon Registry Gift
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 Romantics Travel and their agents 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 Romantics Travel and their agents to charge your credit card for the specified amount, and you agree to the terms and conditions found at
Terms and Conditions
Electronic Signature: (Sign with mouse or touch)