EmailMe Form - Credit Card Authorization Form

EmailMeForm

Today's Date *
MM / DD / YYYY
Name *
First Middle Last
If you are paying on behalf of another traveler please list their name above. (First and Last name of traveler whom you are paying for today)
Email *
Cell Phone *
### - ### - ####
Travel Dates *
Ex. MM/DD/YYYY - MM/DD/YYYY
Booking Number (optional)
Please see invoice for booking number if applicable.
Reason for Payment *
Initial Deposit
Full Payment
Additional Payment
Type of Vacation *
Cruise
All Inclusive International Vacation
United States Vaction Packages
Hotel Only
Name As It Appears on Credit Card *
Payment Amount *
$ Dollars . Cents
Credit Card Type *
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.
Billing Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Additional Information
File Upload

Add File

PLEASE UPLOAD A COPY OF YOUR CREDIT CARD (FRONT & BACK) AND YOUR ID (IF NOT ON FILE). ALSO IF YOU ARE USING A NEW CARD, PLEASE UPLOAD THE NEW CARD INFORMATION.
Terms & Conditions

Thank you for your purchase with MacTravel Services. To complete your transaction and confirm your arrangements, your submission of this authorization form is required. Charges are payable to the hotel, resort, tour operator, cruise line or other travel supplier designated by the above entity. We also may use a third-party payment processing company (Stripe).

I agree to the following terms & conditions:

I certify that I am authorized to use this credit / debit card. I will not dispute the payment with my credit card company as long as the transaction corresponds with the terms indicated above. This payment authorization is for the goods and services described above. By my submission of this form, I give authorization to Corrine Wilkerson (DBA) MacTravel Services and the travel vendor being used to debit my card / debit card for all amounts listed above ONLY. I understand that if I elect to decline Travel Insurance, I am responsible for any cancellation penalties and all out-of-pocket expenses that may occur. I will also make my own provisions in the event of an emergency while I'm away if I elected to forgo travel insurance. *
Yes, I Accept All Terms and Conditions and I authorize charges to my credit card for travel related services.
Signature *
Clear