EmailMe Form - Samantha and Daniel's Tennessee Trip Registration

EmailMeForm

Name As Per Passport #1 *
Prefix First Middle Last
Date Of Birth #1 *
DD / MM / YYYY
WESTJET ID #1
Name As Per Passport #2
Prefix First Middle Last
Date Of Birth #2
DD / MM / YYYY
WESTJET ID #2
Name As Per Passport #3
Prefix First Middle Last
Date of Birth #3
DD / MM / YYYY
WESTJET ID #3
Name As Per Passport #4
Prefix First Middle Last
Date of Birth #4
DD / MM / YYYY
WESTJET ID #4
Name on credit card *
First Middle Last Suffix
Billing Address *

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

Please enter the address that is on file with the card.
Cardholder Phone Number *
### - ### - ####
Email *
This will be used for mailing any electronic documents/itineraries.

Confirm
Payment Details
Please provide payment details below
Credit Card *

Card Number

YOU WILL NOT BE CHARGED ANY AMOUNT AT THIS TIME. Prices will be provided upon receipt of this registration and upon consultation of flights.

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Authorized Amount *
$ Dollars . Cents
YOU WILL NOT BE CHARGED ANY AMOUNT AT THIS TIME. Prices will be provided upon receipt of this registration and upon consultation of flights.
Authorization of Charges *
I do authorize
As named Cardholder; I Authorize: Uniglobe Carefree Travel / Agent Leslie Christian to charge my credit card the above amount, as needed to complete the reserved travel package.

YOU WILL NOT BE CHARGED ANY AMOUNT AT THIS TIME. Prices will be provided upon receipt of this registration and upon consultation of flights.
Authorization of Future Payments *
I authorize my Future Payments
I want to use a different card for Future Payments
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.
Uniglobe Terms and Conditions *
I accept Uniglobe's Terms and Conditions
https://www.uniglobecarefreetravel.com/terms-of-service-saskatchewan
NOTES FOR AGENT:
Bedding requests
Birthday celebrations
Anniversary celebrations
Cross-reference roommates
Dietary restrictions

Payment Details