EmailMeForm
Additional Payment Form
We appreciate your business. We will need the following information as authorization to charge your travel arrangements.
Thank you!
Katie
Reservation #:
*
Payment Information
Name as shown on Credit Card
*
First
Last
Billing Address
*
Street Address
City
State / Province / Region
Postal / Zip Code
Card Number
Expiration
MM
/
YY
CVV
What is this?
3 or 4 digit number printed on the back/front of your credit card
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.
Email
Amount to charge
*
$
Dollars
.
Cents
Additional comments
By submitting, you certify that you are the cardholder and are authorizing the travel agency or its chosen Tour Operator/Supplier to charge the listed amount to the credit card. You certify that you have verified that all information contained in the confirmation you received is accurate. You also certify you have read the Terms & Conditions and the appropriate Travel Protection Plan details. Cancellation penalties may apply. Insurance is not refundable. This charge will be manually applied by the agency to your reservation. If there are any issues, an agent will get back to you. Please note that you will not see a charge from the travel agency on your credit card statement; the charge will come from our supplier and/or the airline directly. Payment may take 3-5 business days to fully process and be reflected on your statement. I authorize the travel agency to use the above information to charge my credit card the stated amount. Completion of this form with a digital signature signifies acceptance in lieu of my physical signature. If agreed, please sign below
*
Clear
Today's Date
*
MM
/
DD
/
YYYY
Total
$0.00
