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PAYMENT AUTHORIZATION | EXISTING TRIP
Use this secure form to authorize Legna Travel to apply a payment to an existing reservation.
Name
*
First
Last
Phone
*
###
-
###
-
####
Email
*
Trip / Destination / Cruise Ship/ Travel Dates:
*
(which destination and approximate date)
Reservation or Confirmation Number
(if available)
PAYMENT DETAILS:
Split Payment Option:
If paying in two installments, please specify the dates for Payment #1 and Payment #2 below.
Payment Amount Authorized
*
$
Dollars
.
Cents
Apply this payment as:
Deposit
Installment/Payment
Final Payment
Other
Payment Date
MM
/
DD
/
YYYY
(if applicable)
PAYMENT METHOD #1
Payment Amount Authorized
*
$
Dollars
.
Cents
Payment #1: Cardholder Name
*
Payment #1: Debit/Credit Card
Card Number
Expiration
MM
/
YY
CVV
What is this?
3 or 4 digit number printed on the back/front of your credit card
Protected in vault
Data collected via fields that have our security seal are encrypted and stored with the highest global security standard — PCI compliance. Your data is absolutely safe in Vault.
Payment #1: Credit Card Billing Address:
*
(please include zip code)
SECOND PAYMENT METHOD — OPTIONAL
Complete only when splitting this payment between two cards.
Payment #2: Payment Amount
$
Dollars
.
Cents
Payment #2: Cardholder Name
*
Payment #2: Debit/Credit Card
Card Number
Expiration
MM
/
YY
CVV
What is this?
3 or 4 digit number printed on the back/front of your credit card
Protected in vault
Data collected via fields that have our security seal are encrypted and stored with the highest global security standard — PCI compliance. Your data is absolutely safe in Vault.
Payment #2: Credit Card Billing Address:
(please include zip code)
TRAVEL PROTECTION
Please select your current travel protection status:
*
I have purchased travel protection.
I would like information about available travel protection options.
I decline travel protection at this time.
Travel Protection Acknowledgment
Travel protection is strongly recommended. Coverage, benefits, exclusions, limitations, and eligibility are determined by the applicable insurance provider and policy.
If I decline travel protection, I understand that I may be financially responsible for nonrefundable payments, cancellation penalties, medical expenses, delays, interruptions, or other travel-related losses.
I acknowledge the travel protection information above.
PAYMENT AUTHORIZATION & ACKNOWLEDGMENT
By signing below, I authorize Legna Travel LLC to charge the payment amount specified above to the payment card(s) provided and to submit the payment to the applicable travel supplier(s) on my behalf.
I understand and agree that:
* Travel pricing, availability, deposits, and supplier terms are subject to change until payment is processed and confirmed.
* Payments may be nonrefundable or subject to cancellation/change penalties according to the applicable supplier's terms.
* Legna Travel acts as a travel advisor/intermediary and does not own, operate, or control airlines, cruise lines, hotels, resorts, tour operators, transportation providers, or other independent travel suppliers.
* I am responsible for reviewing the accuracy of my reservation, including traveler names, dates, itinerary, and other booking details, and for immediately reporting any errors.
* I understand that travel protection is strongly recommended and that declining available coverage may result in financial loss if my plans change or are disrupted.
* I agree to Legna Travel's Terms & Conditions and the applicable travel supplier's terms, conditions, cancellation policies, and payment requirements.
*
I have reviewed and agree to the Payment Authorization & Acknowledgment above.
I have reviewed and agree to Legna Travel LLC's Terms & Conditions.
Authorized Cardholder Name
*
Electronic Signature
By signing and submitting this form, I confirm that I am the authorized cardholder or have authorization to use the payment method provided, and I authorize the transaction described above.
*
Clear
Date Time
*
MM
/
DD
/
YYYY
PAYMENT NOTES
Additional Comments/Suggestions/Notes:
