Payment Authorization Form
Cruisy Susie - CruiseOne Franchise
For Assistance Call: (208) 968-9007
FULL LEGAL NAMES, As On Passport and DATES Of BIRTH for all guests
Room 1 ...
I am submitting payment, to be applied to the account of the above Travelers, for whom, as Primary Traveler, I am able to dictate dates, cost and details of the applicable reservation described below.
Did you remember to list all guests BIRTHDATES above? Accuracy is important
Verified spelling of Full Legal Names, as on Passport/or Certified birth certificate
I understand passenger must be over 2 years of age, or have an Infant Waiver approved
Payment Authorization Terms & Conditions:
As Primary Traveler On Reservation and on behalf of all guests on reservation: I understand this is a disclosure of business practices and permissive credit/debit card payment agreement for the "Coordination of Travel Services". I agree that payments may be made direct to travel Suppliers, on my behalf, by Cruisy Susie/CruiseOne Franchisee or direct to franchise payment processing account when warranted; paid in prorated amounts not to exceed the sum total of approved charges.
FEES: I am aware there are potential Cancellation, Refund and Surcharge Policies and Fees by Travel Suppliers(ie: Cruiselines, Airlines, Hotels. etc); I understand it is my responsibility to read and abide by the policies, terms and conditions as posted on my invoice, provided emails and supplier documents as provided throughout our transaction. I understand that Cruisy Susie/CruiseOne Franchisee will impose the following charges as applicable: 1.) Agency Cancellation Fees: ALL confirmed reservations are subject to cancellation fee of $75 per adult 2) Reservation Change Fee after confirmation review: Changes in traveling guests, travel dates, flight schedule or major component will be assessed a $100 Change Fee, excluding minor corrections 3.) Booking Transfer Request will assess a Service Fees of $100 per adult.
Above fees will be applied to the provided credit card account below, as a separate transaction, prior to release of any refundable funds held by Suppliers.
CruiseOne agency will not be held liable for associated costs due to inaccurate information provided. Cruisy Susie/CruiseOne Franchisee will not release personal information to ANY parties not listed below, unless provided in writing as an Emergency Contact and will apply due diligence in maintaining records in a secured, safe location.
SELECTED Cruiseship & Itinerary (or Resort & Destination if land trip)
Scheduled Date of Departure
This is the date the cruiseship is scheduled to depart, or the date of first night of resort reservation.
Anticipated Price for Total Travel Package
This is the Total Package Quote per current Quote/Email, which includes anticipated payments to be prorated to various suppliers; such as airlines, hotel, cruiseline, resorts, insurance, excursions and guest services-as dictated in the Quoted Travel Package. Each identified charge will be confirmed by paid receipt or updated Invoice. This amount subject to change with any additions/removal of travel activities and will be confirmed by email.
Name As Appears on Card
Cardholders Billing Address
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Saint Kitts and Nevis
Saint Vincent and the Grenadines
Trinidad and Tobago
Bosnia and Herzegovina
United Arab Emirates
Papua New Guinea
Central African Republic
Democratic Republic of the Congo
Republic of the Congo
Sao Tome and Principe
United Republic of Tanzania
Country / Region
Credit / Debit Card
What is this?
3 or 4 digit number printed on the back/front of your credit card
Secured Credit Card Information retained for duration of this transaction only.
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.
Included above should be Required Deposit as found in the provided quote or email. This amount is included in Total Package Quote provided in Email. You MUST pay the balance in full prior to Final Due Date or if booking within 90 Days of Traveling or as noted on Specific Reservation.
Insurance Premium (optional )
Insurance Cost is found in your provided quote or email. Travel Protection Plan premiums are due at time of deposited reservation to ensure maximum coverage of Pre-Existing Medical Conditions. Insurance Premiums are generally not refundable, with few exceptions to terms of cancellations. Insurance may be added later, with limited coverage for pre-existing coverage. As of 03/15/2020, Leisure Care insurance policies will include COVID 19 related cancellations, in travel illness or travel interruptions; however restrictions may apply.
TRAVEL PROTECTION INSURANCE
I ACCEPT the Offer of Travel Protection Insurance, presented by Cruisy Susie /CruiseOne and supplied by Leisure Care or direct from Supplier. I have had the opportunity to review the policy coverage and deem the terms suitable for my needs.
I acknowledge the offer and recommendation of Travel Protection Insurance by Cruisy Susie/CruiseOne and have opted to DECLINE COVERAGE at this time. I understand I can add limited coverage at a later date or purchase it independently.
APPROVAL OF CHARGES
As named Cardholder; I Authorize: Susan Conger/CruiseOne Franchisee to immediately charge my credit card the above noted Deposit and Insurance amounts plus any agreed Service Fee, to complete the reserved Travel Package as listed above.
Future Payment Authorization
I will authorize By EMAIL, all future payments due towards Total Package Cost, to be charged to the above credit card with the same terms as disclosed. I may opt to use a different Credit Card simply by submitting a new Authorization Form.
Acceptance of Mandatory Disclosure
I understand I am responsible to READ the DOT and COVID-19 Disclosure Email that will be generated upon submission. I ACCEPT: I have 24 hours from receipt of Disclosures to submit any dispute or cancellation due to informational content of email.
Email For Receipt Confirmation & Mandatory Disclosure
Signature of Cardholder
Use your mouse. touchpad or touchscreen to sign signature.
All information collected is never shared to parties not involved in travel transaction.