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Y.F.T.S TRAVEL INSURANCE PAYMENT AUTHORIZATION
Y.F.T.S. TRAVEL PROTECTION ISURANCE PAYMENT AUTHORIZATION TO CENTERPIECE EVENT & TRAVEL GROUP
By completion of this form, I authorize Centerpiece Event & Travel Group to make payments on my behalf for Travel Protection Insurance to selected suppliers for the purpose of securing my travel insurance.
I understand that Debit Cards often impose a Daily Charge Limit and multiple payments may be needed to complete the full balance due. In the event this becomes necessary, Centerpiece Event & Travel Group is authorized to process payment and will notify me of payments made.
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TOTAL NUMBER OF PEOPLE ON RESERVATION (Including You)
*
RESERVATION/CONFIRMATION # YOU ARE PAYING ON
(If you have received it)
CREDIT CARD INFORMATION & AUTHORIZATION
PAYMENT AMOUNT BEING AUTHORIZED
*
$
Dollars
.
Cents
NAME AS LISTED ON DEBIT/CREDIT CARD
*
First
Middle
Last
BILLING ADDRESS
*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Aruba
Bahamas
Barbados
Belize
Canada
Cayman Islands
Cook Islands
Costa Rica
Cuba
Dominica
Dominican Republic
El Salvador
Grenada
Guatemala
Haiti
Honduras
Jamaica
Mexico
Netherlands Antilles
Nicaragua
Panama
Puerto Rico
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Trinidad and Tobago
United States
Argentina
Bolivia
Brazil
Chile
Colombia
Ecuador
Guyana
Paraguay
Peru
Suriname
Uruguay
Venezuela
Albania
Andorra
Armenia
Austria
Azerbaijan
Belarus
Belgium
Bosnia and Herzegovina
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Faroe Islands
Finland
France
Georgia
Germany
Greece
Hungary
Iceland
Ireland
Italy
Kosovo
Latvia
Liechtenstein
Lithuania
Luxembourg
Macedonia
Malta
Moldova
Monaco
Montenegro
Netherlands
Norway
Poland
Portugal
Romania
San Marino
Serbia
Slovakia
Slovenia
Spain
Sweden
Switzerland
Ukraine
United Kingdom
Vatican City
Afghanistan
Bahrain
Bangladesh
Bhutan
Brunei Darussalam
Myanmar
Cambodia
China
East Timor
Hong Kong
India
Indonesia
Iran
Iraq
Israel
Japan
Jordan
Kazakhstan
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Lebanon
Malaysia
Maldives
Mongolia
Nepal
Oman
Pakistan
Palestine
Philippines
Qatar
Russia
Saudi Arabia
Singapore
Sri Lanka
Syria
Taiwan
Tajikistan
Thailand
Turkey
Turkmenistan
United Arab Emirates
Uzbekistan
Vietnam
Yemen
Australia
Fiji
Kiribati
Marshall Islands
Micronesia
Nauru
New Zealand
Palau
Papua New Guinea
Samoa
Solomon Islands
Tonga
Tuvalu
Vanuatu
Algeria
Angola
Benin
Botswana
Burkina Faso
Burundi
Cameroon
Cape Verde
Central African Republic
Chad
Comoros
Democratic Republic of the Congo
Republic of the Congo
Djibouti
Egypt
Equatorial Guinea
Eritrea
Ethiopia
Gabon
Gambia
Ghana
Gibraltar
Guinea
Guinea-Bissau
Cote d'Ivoire
Kenya
Lesotho
Liberia
Libya
Madagascar
Malawi
Mali
Mauritania
Mauritius
Morocco
Mozambique
Namibia
Niger
Nigeria
Rwanda
Sao Tome and Principe
Senegal
Seychelles
Sierra Leone
Somalia
South Africa
Sudan
Swaziland
United Republic of Tanzania
Togo
Tunisia
Uganda
Zambia
Zimbabwe
Country / Region
CREDIT CARD TYPE
*
Please select One
VISA
MASTERCARD
AMERICAN EXPRESS
DISCOVER
CREDIT CARD NUMBER
*
EXPIRATION DATE
*
MM
/
YYYY
I hereby authorize CENTERPIECE EVENT & TRAVEL GROUP (agent Tamara Finlayson-Fuller) to immediately charge my credit card in the above listed amount to make any and all payments directly to the supplier for all my approved travel plans.
*
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Please use your mouse, finger or stylus to sign above to authorize payment .
DATE OF CREDIT CARD AUTHORIZATION
*
MM
/
DD
/
YYYY
TERMS AND CONDITIONS:
CENTERPIECE EVENT & TRAVEL GROUP acts only as an agent for airlines, hotels, tour operators, and other suppliers of services and shall not be held responsible for any injury, loss or damage caused by accident or event(s) beyond their control, or by any action or negligence of any persons who are not in their employ.
Neither CENTERPIECE EVENT & TRAVEL GROUP or its agents will accept any responsibility for losses or additional expenses due to delay or changes in air, sea or other services due to sickness, weather, strike, war, or other causes. The right is reserved to make adjustments in the itinerary if deemed necessary.
*Prices are accurate at time of quote and are subject to change until trip is paid in full.
*CENTERPIECE EVENT & TRAVEL GROUP is not an Insurance agent. We offer retail travel services to customers, which are provided by
separate and independent vendors of travel services. CENTERPIECE EVENT & TRAVEL GROUP does not operate, control, or otherwise provide the services of the independent travel vendors. Hence, I agree and understand that CENTERPIECE EVENT & TRAVEL GROUP is not responsible for any operating failures, loss, damage, delay, or injury to you or members of your travelling party, nor for consequential
damages, which may result from failure, delays, or injuries, which arise out of or during your scheduled travel. I agree and understand that CENTERPIECE EVENT & TRAVEL GROUP is not responsible for any damages, direct or consequential, which may arise as a result of acts of God, social or labor unrest, war, political or national strike, terrorist activities, mechanical failures, climatic conditions, or any other
actions or omissions beyond the control of CENTERPIECE EVENT & TRAVEL GROUP.
*FEES: I am aware there are potential Cancellation, Refund and Surcharge Policies and Fees by suppliers; I understand it is my responsibility to read and abide by the policies, terms and conditions as posted on supplier documents and agree not to dispute or chargeback any of the above signed for and acknowledged charges without proper course of action. I understand that CENTERPIECE EVENT & TRAVEL GROUP will impose the following charges as applicable:
1.) All non-insured reservations, are subject to Cancellation Fees of $50 per adult, payable to CENTERPIECE EVENT & TRAVEL GROUP.
2.) While requests for Extension of Payment Due Dates are usually denied by supplier, any such extension action if extended is subject to a $50 Service Fee, , payable to CENTERPIECE EVENT & TRAVEL GROUP.
3.) Booking Transfer Request will assess a Service Fees of $100 per adult: ALL fees will be applied to the credit card account as provided above.
4.) I also understand that it is my responsibility to pay any change fees imposed by the supplier if a correction to my name and/or date of birth is required due to providing CENTERPIECE EVENT & TRAVEL GROUP with incorrect or missing information.
I have read, understood and agree to the Terms and conditions of this agreement.
*
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Please use your mouse, finger or stylus to sign above to acknowledge and agree to the above terms and conditions.