Your Confirmation Number:
Please use your confirmation number,
the invoice number.
Your Name(s) *:
Your Email *:
Is this a Honeymoon Registry Gift?
If so, please provide the couple's name(s):
Credit Card Type *:
Credit Card Type
Payment Type *:
Other OR Final Payment
Honeymoon Registry Gift
Travel Protection *:
I understand that I CANNOT purchase then cancel for any reason the insurance once my deposit is paid.
Additional Comments :
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 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. The Insurance premium is non-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 may 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 and the initialing of this box signifies acceptance in lieu of my signature.
Electronic Signature: (Sign with mouse or touch)*