EmailMe Form - First Choice Travel Group Payment Form

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First Choice Travel Group Payment Form

In order to be confirmed, a reservation form must be completed and a payment collected. Fill out the form in its entirety. Your full name as it appears on your passport or government issued identification card must be entered. This form is encrypted and secured. SSL has been added for secure data transmission. The data is transmitted via AES 256 SSL encryption. Coupled with the "Mask Field" setting enabled, the information is well-secured. You will receive an email confirmation upon processing of payment.

For International Travel: A valid unexpired passport book is required. A passport card is not a valid form of identification when traveling via aircraft internationally. The names on the passport book MUST match the names on the travel reservation.

For Domestic Travel: A valid unexpired government ID is required. The names on the ID must match the names on the travel reservation.

The responsibility to ensure that the names on the passport and/or government ID matches the names on your travel itinerary rests with the traveler. First Choice Travel Agency, LLC. will be held harmless if the traveler is denied entry into/onto any travel component due to mismatched names and/or expired identification.

Name Passenger #1 *
First Middle Last
Birthdate Passenger #1 *
Name Passenger #2
First Middle Last
If you have a roommate & are making a payment on behalf of that roommate, this field is REQUIRED. If you are not making a payment on their behalf, they will need to submit their own form.
Birthdate Passenger #2
Fill in this field if you have filled in the previous one. If not, skip.
Email Address Passenger #1 *
Email Address Passenger #2
Phone Passenger #1 *
### - ### - ####
Phone Passenger #2
### - ### - ####
Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
For what trip are you making a payment towards (Jane Doe's Birthday Celebration or Aruba 9/15/21)? This is important to ensure your payment is applied correctly. *
Do you have a disability that requires special consideration? Without violating your rights, type the type of assistance you require without disclosing your disability (wheelchair, cane etc).
If airfare is a part of your travel itinerary, do you have an airline mileage reward account (ex. Delta SkyMiles) for the airline included in your package? If so, what is your number?
Aisle, Middle, Window Seat?
How Many Beds Do You Require? *
Are you celebrating a special occasion during the trip? If so, what occasion? *
Amount of Payment (ex $100.00) *
Card Type *
Visa
Mastercard
American Express
Discover
Name as it appears on card *
First Middle Last
Card Number *
Expiration Date *
Security Code *
Is the billing address the same as you provided earlier, if no fill in bottom section *
Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
I authorize First Choice Travel Group to process my payment for the amount specified using the credit or debit card I have supplied *
I decline Vacation Protection (insurance) at this time and/or will secure protection on my own *
Please use this space to provide any pertinent information that you wish for the booking agent to know *
Your signature below constitutes your authorization to process your payment. Use your cursor on your mouse to electronically sign the form *
Clear