EmailMe Form - Confirmation and Authorization Form

Name of Trip or Reservation # *

Name of Travel Consultant You're Working With *

Cardholder Name as Appears on Card *

Address - This is the address associated with your debit or credit card billing statement. *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code

Phone *

### - ### - ####

Email *

Would you like to receive travel promotions, sales and tips via email? *

Yes

No

Please read statement below about daily spending limit. Initial in box to indicate you have read and agree. *

Major bank debit cards will most likely have a daily spending limit. Your card may be declined if your purchase is higher than your daily limit, even if you have sufficient funds in your account. It is your responsibility as the purchaser to ensure that your daily limit is high enough to cover your purchase. Please initial in field that you have read and agree to this.

Credit Card *

Travel Insurance / Protection Plan - Select an Option *

Purchase Travel Insurance With Deposit (Most Recommended)

Purchase Travel Insurance With Final Payment

Decline Travel Insurance

Insurance Previously Purchased For This Trip

Travel Documents: Many travel suppliers are going green and send electronic travel documents after final payment. If you have the choice between Free E-Documents and Printed, Packaged & Shipped Documents for a small shipping/handling fee, which do you prefer? *

Free E-Documents

Printed, Packaged & Shipped Documents - I agree to pay the $15.00 shipping/handling fee which will be charged as a separate transaction by your Travel Consultant that you are working with at A Room With A View - Cruise & Travel, LLC.

*Printed, Packaged & Shipped Documents include A Room With A View document envelope, luggage tags and/or other travel goodies.

Amount of Payment *

$ Dollars . Cents

Include the TOTAL amount for payment due at this time for your travel reservation(s), travel insurance (if selected) and printed/packaged/shipped document fee (if selected.)

Auto-Pay Option for Final Payment: By selecting "Yes", you are authorizing the balance due or final payment for this vacation on the card noted on this form on or before final payment due date. *

Yes, I authorize Auto-Pay option for the balance due.

No, I will submit a new confirmation/payment form before final payment due date.

By clicking on the Submit button below I authorize A Room With A View - Cruise & Travel, LLC to charge the amount due for my travel reservation(s) as indicated above. I guarantee and warrant that I am the legal cardholder for this credit or debit card.

I have read over the travel supplier and travel agency terms and conditions (Consumer Disclosure Notices found on our web site under Client Forms and in email) and reviewed the cancel and change penalties. I understand penalties will apply if the booking is changed or canceled. The travel products and services being purchased may be subject to additional surcharges, cost increases and fees imposed by individual travel suppliers or government entities after the purchase date. I understand that I may be charged these post-purchase amounts for reasons varying from currency exchange fluctuations to fuel surcharges and new travel taxes. I consent to these post purchase price increases, and I authorize A Room With A View - Cruise & Travel, LLC to charge my credit card for these amounts due (after notification.) Your credit card will not be automatically charged upon form submission. Print name here and sign name in signature field below indicating that you agree. *

Note: You are merely providing payment information and authorization; your payment is not automatically processed upon submission. Your payment will be processed manually by your travel consultant.

Signature - Sign in box *

Clear

Please note any comments or questions here.
Thank you for your business!