Who is your Travel Agent?
Your Confirmation Number:
Please use your confirmation number,
the invoice number.
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 Guljan Inc. DBA Lange 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 Guljan Inc. DBA Lange 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.
Guljan Inc. DBA: Lange Travel Fla. Seller of Travel Ref. No. ST39107 Andy Lange Travel Professional 904-834-4517 Guljan Inc. DBA: Lange Travel Fla. Seller of Travel Ref. No. ST39107 DISCLOSURE NOTICE The information contained in this registration form, including any attachments, may be confidential and subject to copyright. Any pricing information displayed is not guaranteed until actual full payment or Deposit is made. Be aware that pricing can, and often do, change. Be aware that transmission of information through the internet cannot be guaranteed to be secure or error-free as information could be intercepted, corrupted, lost, destroyed, arrive late or incomplete, or contain viruses. Guljan Inc. DBA Lange Travel does not accept liability for any errors or omissions in the contents of this message, which may arise as result of internet transmission. Please do not send credit card numbers through the internet in form of email messages. Booking and Reservations: Prices and availability are subject to change and are not final until the booking/reservation is confirmed (this includes hotels and ground transportation). A valid form of payment (Cash, credit card, funded personal check, or money order) is needed to finalize bookings and reservations. Some hotels may withdraw funds prior to check-in, while other hotels may process payments at check-in/out. Some hotel reservations are refundable, some are partially refundable, and others are not refundable. Suppliers/Vendors: Lange Travel is acting as an agent for suppliers/vendors in selling travel-related services, or in accepting reservations or booking for services that are not directly supplied by Lange Travel (Such as, but not limited to, air and ground transportation, hotel accommodations, meals, tours, cruises, act.). Lange Travel and its agents, therefore, shall not be responsible for breach in contract or any unintentional or careless actions or missions on part of such suppliers, which results in any loss, damage, delay or injury to you or your companions or group members. Unless the term "guaranteed" is specifically stated in writing on your tickets, invoice, or reservation itinerary, Guljan Inc. DBA Lange Travel does not guarantee any such "suppliers" rates, bookings, reservations, connections, scheduling or handling of personal effects. Lange Travel is not responsible for cancellation or any services and/or refunds from any supplier or carrier that may cease operations.
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)