EmailMe Form -

MAKE YOUR SECURE PAYMENTS HERE

Name

First Last

Name as it appears on your credit card.

Email *

This email will be used for sending any electronic documents/itineraries.

Phone Number

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

Booking #

By entering your booking # you are authorizing us to make payment on your behalf to the supplier of your booking.

Authorized amount to be Charged

$ Dollars . Cents

Payment amount you are authorizing to the supplier of your booking.

Card Type

Identification Upload

Name on ID must match name on the card used for payment.

Credit Card

Billing Address

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

**Be sure to input your correct billing address and zip code.

CREDIT CARD PAYMENT AUTHORIZATION

I hereby authorize my travel agent to apply my payment to the travel vendor of my booking via the credit card listed above. I guarantee and warrant that I am the legal cardholder for the credit card information listed above and that the billing address matches the credit card information provided.

Authorization of Future Charges:

Email or text your agent with the information below:

Name, booking #, payment amount, and type that you authorize payment with the credit card on file ending in XXXX (type out the last 4 digits of the card on file to be used for payment)

I authorize future payments owed towards the balance of my travel booking to be charged to the above credit card with the same terms as disclosed above.

I do not authorize future payments. I will submit a new inquiry for future payments.

Additional information

Signature *

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