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Y.F.T.S 2018 CC AUTHORIZATION & PROFILE FORM
CENTERPIECE EVENT & TRAVEL GROUP
I understand this form confirms an agreed contract for Travel Service and the authorization of Payment for the Debit/Credit Card Listed. By completion of this form, I authorize Centerpiece Event & Travel Group to make payments on my behalf to selected suppliers for the purpose of securing my travel arrangements for the 2018 Jamaica Experience.
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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NUMBER OF PEOPLE TRAVELING (Including You)
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PERSONAL INFORMATION
PRIMARY TRAVELER'S NAME
*
First
Middle
Last
As Listed On Government Issued ID that will be used for travel
DATE OF BIRTH
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MM
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DD
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YYYY
Email
*
Phone
*
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Address
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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
DO YOU HAVE A PASSPORT?
*
YES
NO
PASSPORT NUMBER
PRIMARY TRAVELER PASSPORT EXPIRATION DATE
MM
/
DD
/
YYYY
DO ALL MEMBERS OF YOUR PARTY HAVE A VALID PASSPORT?
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YES
NO
I DO NOT KNOW
PERSONAL INFORMATION OF TRAVELER # 2
NAME OF TRAVELER # 2
First
Last
As listed on government issued ID that will be used for travel.
DATE OF BIRTH
MM
/
DD
/
YYYY
DO YOU HAVE A PASSPORT?
YES
NO
PASSPORT NUMBER
PASSPORT EXPIRATION DATE
MM
/
DD
/
YYYY
EMAIL
CONTACT #
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TRAVELER # 2 ADDRESS (IF DIFFERENT FROM PRIMARY
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
TRAVEL INSURANCE
I understand that CENTERPIECE EVENT & TRAVEL GROUP recommends Travel Insurance to cover my vacation investment.
I understand that my purchase may not be refundable without full Travel Protection Insurance and that purchase of travel Protection Insurance can protect me from possible loss of my deposit and all future payments due to supplier bankruptcy/default, unexpected trip cancellation/interruption due to an accident, illness or death (of myself or family members), baggage loss, medical expenses and emergency air transportation costs. I also acknowledge that I am being made aware, that in order to obtain maximum coverage for pre-existing conditions, I must purchase Travel Protection Insurance within 14 days of paying my initial deposit (Limitations may apply).
** I acknowledge that if I decline the purchase of travel insurance being offered, any penalties or cancellation fees are my responsibility.
** I acknowledge that Insurance is provided by a third party company or supplier; in the event of a cancellation, my reimbursement will be determined by the terms of my policy and will be minus the cost of insurance.
** I acknowledge that I will refer to my specific insurance plan for coverage information.
Signature
*
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Please use your mouse, finger or stylus to sign above to authorize acknowledgement of terms outlined for Travel Protection Insurance.
**Please select the option of your choice based on the Insurance plans offered to you by your Centerpiece Event & Travel Group Agent.
(Once I get your profile form I will send you an email with the cost of your travel protection and a separate payment link for payment)
*
YES - I would like to purchase Travel Insurance at this time.
NO - I choose not to protect my travel investment at this time.
I may choose to purchase travel insurance at a later date, I understand restricions may apply.
DATE TRAVEL INSURANCE PURCHASED OR DECLINED.
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MM
/
DD
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YYYY
CREDIT CARD INFORMATION & AUTHORIZATION
DEPOSIT/PAYMENT AMOUNT BEING AUTHORIZED
*
$
Dollars
.
Cents
NAME AS LISTED ON DEBIT/CREDIT CARD
*
First
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
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YYYY
HAZARDOUS MATERIALS ACKNOWLEDGEMENT
Federal law prohibits the carriage of certain hazardous materials aboard aircraft in your luggage or on your person and could result in a fine. Visit www.tsa.gov and click on “prohibited items” for more information, or see below for additional info.
In instances where a single person (the group leader), is acting on behalf of a group of passengers in relation to the ticket purchase and check-in processes, that single person is assuming the responsibility of providing hazardous materials restrictions to each passenger traveling, and is responsible for providing the indication of understanding on behalf of the group. Federal law forbids the carriage of hazardous materials aboard aircraft in your luggage or on your person. A violation can result in five years' imprisonment and penalties of $250,000 or more (49 U.S.C. 5124). Hazardous materials include explosives, compressed gases, flammable liquids and solids, oxidizers, poisons, corrosives and radioactive materials. Examples: Paints, lighter fluid, fireworks, tear gases, oxygen bottles, and radio-pharmaceuticals. There are special exceptions for small quantities (up to 70 ounces total) of medicinal and toilet articles carried in your luggage and certain smoking materials carried on your person. Please refer to the full list of TSA prohibited items at http://www.tsa.gov/traveler-information/prohibited-items.
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Please use your mouse, finger or stylus to sign above to acknowledge and agree to the above terms and conditions.
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.
*Passports: All international trips require a Passport valid for at least 6 months beyond the date of departure. Any and all additional Visa's or travel documents required are the sole responsibility of the traveler.
*Air Travel : Flight details including departure times are always subject to change by the airlines and are not under the control of CENTERPIECE EVENT & TRAVEL GROUP. It is the travelers responsibility to check in for the flight 24 hours in advance and reconfirm all gates and times.
*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, 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, 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.
*Travel Insurance : CENTERPIECE EVENT & TRAVEL GROUP offers Travel Protection that can help minimize the monetary loss incurred due to unforseen events beyond my control such as: cancellation, missed connections, baggage loss, trip delay, and especially medical emergencies.
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.