Who is your Travel Agent?
Your Confirmation Number:
Please use your confirmation number found on your invoice.
Travel Insurance Declined
Is this a Honeymoon Registry Gift?
If so, please provide the couple's name(s):
Credit Card Type
Credit Card Type
Disney Gift Card
Other OR Final Payment
Honeymoon Registry Gift
I understand that I CANNOT purchase the cancel for any reason insurance once my deposit is paid. I understand that I can not add insurance to my Disney reservation through Disney after I am paid in full. If I wish to purchase insurance after this I will have to use 3rd party insurance and the price may or may not be more than what Disney offers. I understand that my travel agent at Twice As Nice Travel has offered me insurance to protect my travel.
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.
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)