EmailMe Form - Belize The Vibe

Primary Name On The Booking *
First Middle Last
As it appears on the passport.
Date Of Birth *
MM / DD / YYYY
Gender *
Female
Male
Phone *
### - ### - ####
Email *
Will you be rooming with others? *
Yes
No
How many adults will be sharing a room including you? *
1
2
3
4
5
6
Room Type: *
1-Bedroom Cabana Loft
2-Bedroom Bayview Condo
3-Bedroom Bayview Condo
Other
Please provide the booking mate information:

Full Name, Date of Birth, Gender, & E-mail address
Please provide the airport information, if you received a price for your departure airport.
Name on the Credit/Debit Card *
First Last
Billing Address *

Street Address City State / Province / Region Postal / Zip Code
Authorized Amount *
$ Dollars . Cents
MINIMUM DEPOSIT required to initiate reservation.
Credit Card *

Card Number

Protected in vault Data collected via fields that have our security seal are encrypted and stored with the highest global security standard — PCI compliance. Your data is absolutely safe in Vault.
Authorization of Charges *
I do authorize
As named Cardholder; I Authorize: The Experience By Sommer Monike/Agent- Sommer Monike to immediately charge my credit card the above amount, as needed to complete the reserved Travel Package account for the Traveler listed above. In addition to the non-refundable travel protection fee of $35 per person.
Pre-Departure Travel Protection *
ACCEPT: I have selected to PURCHASE Travel Protection as offered by The Experience By Sommer Monike. I have reviewed the Policy Coverage and accept that the policy meets my desired protection plus I understand that cost is non-refundable.
DECLINE: I acknowledge that I have received Travel Protection information and quote; I am WAIVING access to these coverage provisions by DECLINING to purchase the travel protection offered by The Experience By Sommer Monike for my travel plans.
**If ACCEPTING: I have added the travel protection cost to the deposit amount and/or intend to pay the additional amount within the grace period, if applicable. Travel Protection Costs are always non-refundable.

**If DECLINING: The Experience By Sommer Monike will not be held liable for any financial losses incurred from failure to purchase travel protection coverage. Travel Protection Costs are always non-refundable.
Booking Mate Cancellation Policies *
I agree and understand the booking mate cancellation agreement and policy listed below:
I am aware that in the instance that myself or booking mate cancels that the parties left on the booking will be affected. Their individual price(s) will increase since the occupancy is changing.
Signature *
Clear