EmailMe Form - Credit Card Authorization Form

Traveler Full Legal Name *
First Last
Travel Agent *
Joslynne Light
Brittany Parker
Wade Light
Kevin Smith
Date of Birth *
MM / DD / YYYY
Please enter Date of Birth for Primary Passenger
Destination
If this is an initial deposit please enter destination
Billing Address *

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

Please enter the address that is on file with the card.
Email *
This will be used for mailing any electronic documents/itineraries.

Confirm
Payment Details
Please provide payment details below
Authorized Amount *
$ Dollars . Cents
Credit Card *

Card Number

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.
Authorization of Charges *
I do authorize
As named Cardholder; I Authorize: Light Travels LLC to immediately charge my credit card the above amount, as needed to complete the reserved Travel Package account for the Primary Traveler listed above.
Cancellation Policies *
Passports and their procurement and validity dates are the responsibility of the client's and I acknowledge that Light Travels INC is not responsible for passport issues.
I agree that should I cancel and did not purchase trip protection that I forfeit all money paid.
Passports and their procurement and validity dates are the responsibility of the client's and I acknowledge that Light Travels INC is not responsible for passport issues.

Your trip is a significant investment, and I, your travel agent, recommend the purchase of travel insurance. If you choose to decline this protection, you are assuming any financial loss associated with your travel arrangements. By declining to purchase travel insurance you fully understand that your travel agent is not liable or responsible for any expenses incurred as a result of cancellation or interruption, emergency medical and transportation, baggage and personal effects, flight and travel accident, and/ or rental car physical damage.

By your acknowledgment above, you have been informed of the cancellation policies for our travel services and have been made aware of the benefits of travel protection. If you choose not to purchase travel insurance, you understand that the premium is non-refundable, even if you should need to file a claim.

Payment Details