PAYMENT INFORMATION FOR GROUP BOOKING
Congratulations, we are to the final booking stage of your vacation! I would like to make your vacation hassle free and finalizing accurate paperwork is an essential step. In an effort to ensure proper travel documentation requirements are met and security issues are avoided; please complete the following form fully and accurately. All submitted information is secure, properly protected, and used exclusively for your upcoming reservation. It comes only to me, Jana Huse, via email and then I will input to confirm the reservation.
Person making the reservation:
Best Contact Phone while traveling:
Please enter the reservation confirmation number that you have reviewed and approve:
Any comments or additional changes we have discussed?
Now that you have arranged your trip, as your professional travel agent I feel that is is my responsibility to recommend travel insurance to protect your investment. Please read and review carefully the separate email providing insurance prices and details so you can make an informed decision concerning this important matter. Ask us or call us with any questions you may have.
AT THE TIME OF FIRST PAYMENT
I have been advised of the cancellation penalties for my purchase. I acknowledge receipt of the insurance email and details.
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.
I understand that I must purchase Travel Insurance immediately to obtain coverage for pre-existing conditions or by final payment for general coverage.
Our choice for travel insurance --
I would like to purchase the Cancel For Any Reason policy per the quote I received at this time.
I would like to purchase the Classic Policy per the quote I received at this time
I would like Basic Insurance per the quote I received at this time
I do not wish to purchase travel insurance.
I would like to think about it.
I would like to purchase the following coverage before final payment.
For airline booking, do you prefer aisle or window seat?
There are two options for payments. The price quoted is full retail, including credit card fees. if you would like to process via eCheck, we can offer a 3% cash discount.
To take advantage of the cash discount, please provide banking information.
I have authorized Jana Huse with Travelooza LLC to charge deposits/trip costs as listed below by processing with the appropriate Supplier to my credit card or bank account as detailed below:
Bank Routing Number
Bank Account Number
To use credit card payment, please provide details.
Payment Amount authorized for the Initial Deposit.
The deposit is the amount required to initiate a reservation on your behalf.
Remaining Balance authorized to be charged to this card by final payment deadline.
This is the total remaining balance due. If unsure of the amount, enter 0.00. **If you intend to pay using a different card for final payment, a new credit card authorization form is required to be submitted at least 48 hours before the final payment due date.
To set up a payment plan, enter the monthlypayment amount you want to be charged to this card, if any.
If we have discussed a payment plan, please indicate the dollar amount you wish to be charged to this credit card every month until the reservation is paid in full. To indicate what day of the month we should process your payment, please provide a date below.
If you are choosing not to make monthly payments or if you have paid your reservation in full, please enter $0.00 at this time.
If you want to make payments but not fixed amounts, please explain what you would like. OR you can just call or email when you would like to make a payment.
Date you want monthly payment to start, if any:
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.
Signature of Cardholder: please type name
Billing Address of Card
Address Line 2
State / Province / Region
Postal / Zip Code