EmailMe Form - Payment Submission CC Authorization

Payment Submission CC Authorization

Complete and electronically sign this form to authorize Indulgence Travel to process a payment using to your credit card listed below.

Rest assured your credit card entry data of sensitive is encrypted and stored in our Secure Form Vault. This form has SSL encryption enabled by default. Which means that the data you provide is transmitted via AES 256 SSL encryption standard.

By signing this form you give Indulgence Travel permission to process payment from your account for the amount indicated on or after the indicated date. Please note: Quoted prices are not guaranteed. Prices are subject to change until payment is processed.

Primary Traveler Name as it appears on Passport *
First Middle Last
Date of Birth *
MM / DD / YYYY
Reservation/Booking Number
Payment Details
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.
Authorized Amount *
$ Dollars . Cents
MINIMUM DEPOSIT OR REQUIRED PAYMENT amount required today to initiate or finalize reservation. (The date of travel, number of paying guests and supplier terms will be factered in computing required deposit amounts.) 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 75 Days of Traveling.
Billing Address *

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

Please enter the address that is on file with the card.
Phone Number
### - ### - ####
Cardholder's primary email address
This will be used for mailing any electronic documents/itineraries.
Travel Insurance *
I have read the travel insurance acknowledgment below and will ACCEPT travel insurance for my vacation
I have read the travel insurance acknowledgment below and will DECLINEtravel insurance for my vacation
Emergencies can happen when you least expect them. [NAME OF BUSINESS] highly recommends that all clients purchase a travel insurance policy to protect their investment in their travel. Cruise lines, airlines, hotels, and tour operators all charge high penalties for cancellation, ranging from the full deposit to no refund at all. And, keep in mind that most health insurance policies will not cover you when you are out of the country. Travel insurance can protect you in the event of Trip Cancellation, Trip Delay, Trip Interruption, Missed Connection, Baggage Loss, Theft or Damage, Baggage Delay, Emergency Medical and Dental Expenses, and Emergency Medical Transportation, among other unforeseen circumstances. Please also note that in order for you to obtain coverage for certain pre-existing conditions, or for supplier default, your policy must be purchased at the time of booking or shortly thereafter (depending on the terms of the policy). Please understand that we are not registered insurance agents, and cannot legally provide specific advice or information regarding insurance. We will gladly secure a quote for you, upon request, and if Indulgence Travel does not, or is not legally able to secure coverage on your behalf, it is our strong recommendation that you purchase a policy on your own. I acknowledge that Indulgence Travel has recommended or offered travel insurance protection to me. Should I choose not to purchase such a policy, I accept all responsibility for declining to secure coverage. Travel Insurance Acknowledgement
CC Authorization *
I authorize
I authorize Indulgence Travel to charge the card reference in the above in the amount amount shown above and by authorizing this charge, I am agreeing to Indulgence Travel's Terms & Conditions of booking, which are located at
https://www.indulgence-travel.com/AboutMe-TC, including the agency’s and principal supplier policies cancelation and refund policies, which may limit my right to a refund in the event that I choose to cancel or change my plans.
Signature
Clear