Travels by Charlotte Trip Deposit
The purpose of this credit card authorization form is to protect you, our valued clients, as well as Travels By Charlotte from credit card fraud. All information on this form will be kept strictly confidential and encrypted. This form MUST be submitted before any credit card payments for travel on your behalf will be made.
{{ Cognito.resources['order-transaction-details-header'] }}
{{ Cognito.resources['order-number-label'] }}: {binding displayValue}
{{ Cognito.resources['order-date-label'] }}: {binding displayValue}
{{ Cognito.resources['order-method-label'] }}: {binding MethodReference}
| {binding Group} | |
| {binding Name} - {binding Description} | {binding displayValue} |
| {{ Cognito.resources['payment-subtotal'] + ":" }} | {binding displayValue} |
| {{ Cognito.resources['order-total-label'] }}: {binding displayValue} | |
Today's Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Your Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Mobile Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Alternative Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Vacation Details
Departure Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Return Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Resort Name: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Travelers' Information
NAMES MUST BE AS THEY APPEAR ON YOUR PASSPORTS FULL COMPLETE NAME-NO INITIALS
Failure to give proper name will result in denial into your destination which would result in no refunds- read form completely before signing. If traveling within the USA you do not need to include your passport information unless you will be using your passport as your identification at check in.(Include all traveling with you as well as yourself. Print names as they appear on passports, If not traveling internationally print names as they appear on Government Issued ID.)
Roommate Information
Traveler # {binding ItemNumber}
Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Date of Birth {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Nearest Major Airport {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Allergies/Special Accommodations
Please provide any specific allergies or special accommodation needs below: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
Emergency Contact Person
Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Relationship {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Contact Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
A passport is required in order to go on this trip. This does not affect your ability to register for this trip at this time so please submit your payment as soon as possible. Just be aware that you are responsible for obtaining a valid passport.
Please either apply for a new passport or renew your passport if it expires after the date given. It takes 4-6 weeks to receive your passport in the mail.
CLICK HERE to begin the process.
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Passport Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Issue Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Expiration Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
- Spelling of name must be exactly as it appears on your valid passport book.
- Travels By Charlotte is not responsible for denied boarding if provided with incorrect passenger information or if your passport is expired, not valid or incorrect proof of citizenship.
- It is the responsibility of the passenger to confirm entry into another country if passport expires in 6 months or less at time of travel or if eligible to travel to all countries that are part of their travel itinerary. This includes any stops in countries which may be part of the “in-transit” itinerary.
- If you are unsure about your eligibility to travel, including restrictions due to criminal records, child support issues or DUI’s please inform me immediately.
- All bookings are non-refundable.
- Any changes to the reservation will result in fees
Travel Protection
I understand that by checking the appropriate box, I am accepting or declining travel insurance for the entire party on this itinerary/form and if we are accepting, the amount is added to the deposit amount that is due. I have been given travel insurance information and I am accepting or declining to purchase with full knowledge of the coverage and have been explained the importance of travel insurance. I understand that if my roommate cancelsand if I do not have the insurance I will lose all monies paid to date. I also understand that if my roommate cancels and I decide I still wish to go, I will pay the new single rate at the rate of time of changing the booking.
Credit Card Information
Name on Credit Card {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Billing Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Credit Card Type {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Credit Card Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
3 Digit Security Code {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Expiration Month {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Expiration Year {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Deposit Amount {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Travel Protection Amount {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Electronic Signature Agreement
Please provide your name as your signature below. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Travels by Charlotte | charlotte@travelsbycharlotte.com | 219-736-0228
[Name of Trip]
Thanks for your payment!
Office Only
Reservation Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Authorization Code {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Date Payment Submitted {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Beginning Balance {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Payment Amount {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Adjusted Balance {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Next Payment Due Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Note to Client {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }