EmailMe Form - itravelwise.com/ccauth

Reservation Number *
Your Reservation Number can be located in your email provided by your agent.
Agent's Name: *
Cardholder's Name: *
First Last
Passenger Name(s) as they reflect on the passport: *
Agree to Ticket Name matches Passport Name *
I confirm that I have reviewed and verified that the name on my passport matches the name on my ticket.
It is the passenger's responsibility to ensure that the name on the ticket matches the name on the passport. Any fees incurred for name changes, whether due to misspellings or mismatches, will be the passenger's responsibility. For multiple passengers, please provide all passport names in the designated space above.
Amount to be charged: *
$ Dollars . Cents
The amount charged may appear on your statement from one of our travel suppliers, including airlines, merchants, or directly from Travelwise International. The total of these charges will align with the amount specified on your invoice. If you have any questions, please don't hesitate to contact us.
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.
Cardholder's Billing Address: *

Street Address City State / Province / Region Postal / Zip Code Country / Region
By clicking yes, you agree for Travelwise to authorize payment on your behalf. *
Yes
No
Travel Insurance *
Yes, I would like to protect my travel investment
No, I understand the risks and decline to purchase travel insurance
Agree to Client Service Agreement *
Yes, I agree to Travelwise International Inc.'s Client Service Agreement.
Click to view Client Service Agreement
Agree to Terms & Condition *
Yes, I agree to Travelwise International Inc.'s Terms & Conditions Agreement.
https://itravelwise.com/termsandconditions/

Click to view Terms and Conditions Agreement

I, the client, acknowledge that I have read, understood, and accepted the conditions outlined in the Travelwise International Inc. Client Service Agreement and Terms & Conditions, as provided above and below. I understand that Travelwise International Inc. acts solely as an agent, not the principal, and is governed by the terms and conditions of its suppliers (including airlines, hotels, cruises, trains, transportation, tour operators, and other travel providers). I acknowledge that cancellations are nonrefundable, unless covered by cancel-for-any-reason insurance or travel insurance (when available and purchased by the client). I accept that applicable fees will apply and confirm that I am an authorized signatory for the credit card listed above. I further agree to cover any additional penalties or costs associated with the specified charge. By submitting this form, I affirm that I have read, understood, and accepted the terms outlined in both the Terms & Conditions and the Client Service Agreement.
Signature *
Clear
Today's Date *
MM / DD / YYYY
Email Confirmation
If you would like to receive an email confirmation, please enter your email address below.
Card holder's Email Address

Confirm
Card Holder's Phone *
### - ### - ####

Email Confirmation