EmailMe Form - A-2022 LST- PAYMENT AUTHORIZATION FORM

LS Travel Agency Payment Authorization Terms & Coinditions:

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 purchase of travel services. I agree that payments may be made direct to selected travel suppliers on my behalf by LS Travel Agency; paid in prorated amounts not to exceed the sum total of approved charges. I understand Debit Cards often impose “Daily Charge Limits” and multiple payments may be needed to complete the full balance due; for which you will be notified if the situation occurs.

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 acknowledge charges without proper course of action.

LS Travel Agency 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.

Coronavirus (COVID19)
Please be aware that local government measures and guidelines put in place by individual travel services providers – including hotels, transfer, car rental, theme parks, tours, events and other ancillaries – are leading to social distancing measures to protect travellers.

Therefore it is likely that hotel guests may find that some facilities – for example the swimming pool, gym area, or buffet halls – will understandably not be available; equally travellers with tickets for theme parks, tours and other activities might find some elements have been adapted or removed; and in the case of multi-day tours different restrictions could be imposed by different local authorities (nonetheless we will endeavor to provide the most accurate and up-to-date information).

Additionally please note that it is the responsibility of the traveler to choose the most appropriate rates – whether that be flexible or non-refundable – when booking hotels, transfers, car rentals, theme parks, tours, events and other ancillaries, according to their needs in view of current COVID-19 travel restrictions. Therefore for new bookings created as of or later than June 1st, cancellations will be processed according to the applicable terms & conditions of the booking.

Client Code:

For Office Use Only

Hotel/Resort Name:

Departure date: *

MM / DD / YYYY

Return date: *

MM / DD / YYYY

Room Category *

Room Occupancy: *

Bed Preference: *

1-King Bed

2-Double Beds

Other

Do you want to include flight to your reservation?

Yes

No

Other

Flight Seat Preference:

Window

Aisle

Middle

(Southwest Airlines Not Included)

List ALL traveler(s) on the reservation for which payment is being applied. Include Full Name & Date Of Birth for each traveler below.

Traveler(s) Information:

I am submitting payment to be applied to the account of the above traveler.

CREDIT CARD HOLDER Information:

Name: *

First Last

(Exactly as it appears on credit card)

Middle Name: *

As it appears on CC. Type N/A if it doesn't apply

Date of Birth

MM / DD / YYYY

Billing Address On CC:

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

*REQUIRED: (The Address above should match what your financial institution has on file)

Phone: *

### - ### - ####

Credit Card Type *

Credit Card *

Payment Type: *

Deposit Amount

Payment on Existing Reservation

Payment In Full

Other explanation how to apply monies?

VACATION PROTECTION INSURANCE: All guest must sign a disclosure Accepting or Declining Travel Portection Insurance prior to issuance of final documents. Cost of Insurance Premium is never refundable once purchased.

Do you want Travel Insurance Coverage? *

YES. I want Travel Insurance Coverage included

NO. I Do Not Want Travel Insurance Coverage included at this time.

Do you understand if you should cancel your trip, the cost of travel insurance is non-refundable? *

YES. I understand these conditions

NO. I Do Not understand these conditions

I, Declined Travel Insurance coverage

TRAVELER(s) TRAVEL INSURANCE Deposit/Payment Included:

List ALL traveler(s) on the reservation for which TRAVEL INSURANCE is being applied. Please include: Legal Full Name & DOB for each traveler.

I am submitting payment to be applied to the account for the traveler(s) listed above for Travel Insurance.

Credit Card Holder TOTAL AMOUNT AUTHORIZED:

Credit Card Holder Total Amount you are authorizing including Travel Ins coverage and payments for ALL traveler(s) listed above. *

$ Dollars . Cents

How do you prefer to receive Updates & Documents?

By Email

By Mail (Mailing address below)

I, Acknowledge there will be a Cancellation fee from the Supplier based on their terms and conditions at the time of cancellation. This applies to all guest(s) and are assessed in the event of either partial or full cancellation.

I, acknowledge there will be a cancellation fee if I should cancel my trip *

YES. I understand these conditions

NO. I Do Not understand these conditions

Other

I, Acknowledge there will be a Cancellation fee of $25.00/pp made payable to "Lisa Streater" at LS Travel Agency shall I decide to cancel my trip. This applies to all guest(s) and are assessed in the event of either partial or full cancellation.

I, acknowledge there will be a cancellation fee if I should cancel my trip *

YES. I understand these conditions

NO. I Do Not understand these conditions

Other

PASSPORT INFORMATION: If your travel plans include International Flight, please fill out the additional passport questions below.

Do You Have A Valid Passport? *

Yes. I Have A Valid Passport

No. I am in the process of applying for my passport

Other

Alert: It is strongly suggested that all travelers exiting the US, in any form of transportation have a valid passport book for a minimum of 6-months expiration. In the event of an emergency, no other documents will be accepted for inbound foreign flights. Travelers are responsible for meeting all documents requirement for travel. For complete regulations regarding passport requirements, visit www.travel.state.gov.

Other Passport Explanation?

Full Name On Passport:

First Middle Last

(Exactly as it appears on your passport) N/A If you do not have a Middle Name

Other Citizenship?

Please select all that apply for traveling party.

Special Occasion?

Please include dates and additional details below.

Special Occasion Date?

MM / DD / YYYY

Emergency Contact Name (Not Traveling With You):

First Last

Emergency Contact Phone:

### - ### - ####

Client other request(s)?

Please be as detailed as possible.

APPROVAL OF CHARGES:

As named Cardholder, I authorize Lisa Streater at LS Travel Agency to immediately charge my credit card the above amount including any additional payments required, as needed to complete the reserved Travel Package account for the primary travelers 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.

Signature *

Clear

Use your "mouse" to sign your name.

Print Name: *

First Last

Today's Date: *

MM / DD / YYYY

Email: *

For receipt confirmation and any other documents reference your trip.

Lisa Streater ~ LS Travel Agency
Phone: 301-246-2496
Email: info@lstravels.com
Web: www.lstravels.com
Office Hours: Mon-Fri 9:00am-6:00pm
(Quicker response thru email)