EmailMe Form - CREDIT CARD AUTHORIZATION FORM

TRIP INFORMATION

NAME OF TRAVELER(S) *

Enter the names of the travelers for which this payment applies.

PURPOSE OF PAYMENT *

Please enter a short description of your trip. Or enter your booking number if known

TRAVEL INSURANCE

I have been advised of the cancellation penalties for my purchase.
I acknowledge that I have been provided access to a Travel Insurance Plan.
I understand that Travel Insurance can protect me from possible loss of money due to supplier bankruptcy/default, unexpected trip cancellation/interruption due to accident, sickness or death, baggage loss, medical expenses, and emergency air transportation costs.

TRAVEL INSURANCE OPTION *

At this time, I have decided to Purchase travel insurance.

At this time, I have decided NOT to Purchase travel insurance.

TERMS AND CONDITIONS

◊ I have been informed of the cancellation policies for our travel services and have been made aware of the benefits of travel protection.

◊ Violet Clover Travel Group has provided me with the travel supplier’s Terms and Conditions of service. I have read, understood, and consent to the stated terms.

◊ Violet Clover Travel Group has provided me their Terms and Conditions of service (https://www.violetclovertravelgroup.com/terms-and-conditions). I have read, understood, and consent to the stated terms.

CREDIT CARD INFORMATION

CARD HOLDER NAME *

First Middle Last

Please enter your name as it appears on your credit card.

BILLING ADDRESS *

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

EMAIL ADDRESS *

Confirm

CREDIT CARD TYPE *

CREDIT CARD NUMBER *

EXPIRATION DATE *

MM / YYYY

SECURITY CODE *

PAYMENT AMOUNT *

$ Dollars . Cents

WHICH PAYMENT? *

DEPOSIT

INTERIM PAYMENT

FINAL PAYMENT

SIGNATURE TO AUTHORIZE PAYMENT *

Clear

I, the authorized credit card user, give Violet Clover Travel Group and its representative express authorization to charge my credit card for the purposes detailed above. I understand that this form constitutes a legally binding contract and that by submitting this form, I will be held responsible for all agreed upon charges as well as any and all collection and legal fees. By submitting this form, I acknowledge receipt and understanding of its contents. Note: Your card will not automatically be charged by completing and submitting this form; however, completing and submitting this form does give the agent the right to charge the card for the amount and purpose authorized above.

Disclaimer

Violet Clover Travel Group offers retail travel services to customers, which are provided by separate and independent vendors of travel services. Violet Clover Travel Group does not operate, control, or otherwise provide the services of the independent travel vendors. Hence, customer agrees that Violet Clover Travel Group acts only as agent for the client in acquiring transportation, hotel accommodations, sightseeing and other privileges, or services for the clients’ benefit, and on the express condition that Violet Clover Travel Group shall not be responsible for any loss, accident, injury, delay, defect, omission or irregularity which may occur or be occasioned, whether by reason of any act, negligence or default of any company or person engaged in or responsible for carrying out any of the arrangements, or otherwise in connection therewith.

By submitting this inquiry form the client is agreeing to these terms and conditions, along with all other terms and conditions of service of Violet Clover Travel Group.