Who is your Travel Agent
Your Confirmation Number:
Please use your confirmation number,
the invoice number.
Your Name(s) *:
Your Email *:
Credit Card Type *:
Credit Card Type
Disney Gift Card
Payment Type *:
Other OR Final Payment
Honeymoon Registry Gift
Travel Protection *:
I understand that I CANNOT purchase the cancel for any reason insurance once my deposit is paid.
Additional Comments :
Accept or Decline Insurance * :
Phone Number * :
By submitting, you certify that you are the cardholder and are authorizing the travel agency or its chosen Tour Operator/Supplier/Cruise Line to charge the amount listed 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 Travel Insurance/Protection Plan details, where applicable. 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 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 and the initialing of this box signifies acceptance in lieu of my signature.
By checking the box below and adding your signature, you indicate that the above amount is correct, you authorize the travel agency to charge your credit card for the specified amount, and you agree to the terms and conditions.
Electronic Signature: (Sign with mouse or touch)*