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.
{ binding firstError.message }
Your Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }

Please provide your FULL NAME as it appears on your passport OR birth certificate. (Your form of ID must match your boarding pass.)

{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }

Untitled

Vacation Details

{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
Please select your room type: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }

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 firstError.message }
{ binding firstError.message }
Gender {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }

Information required for travelers 21+ years old

{ binding firstError.message }

Information required for travelers 21+ years old

{ binding firstError.message }
Allergies/Special Accommodations
Please select one or more choices {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
Emergency Contact Person

Only one emergency contact per family is needed

Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
Do you currently have a passport with at least 2 blank pages and with an expiration date after (date six months after return date)? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }

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. 

Passport Requirement Acknowledgement {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Untitled
{ binding firstError.message }
Nationality {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Country of Issue {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
  • 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
Passport/Government ID Information & Status Acknowledgement {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }

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.
I have been advised of the option to purchase travel protection. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Would you like to accept or decline travel protection? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }

Credit Card Information

Name on Credit Card {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Billing Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }

{ binding firstError.message }
{ binding firstError.message }

If denying the travel insurance, you do not need to add the insurance amount to your total deposit to be paid.

Will you be the only one submitting payments for everyone on your reservation? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Information and Credit Card Information Acknowledgement {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }

Terms and Conditions

{ binding firstError.message }
{ binding firstError.message }

Electronic Signature Agreement

Terms {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Please provide your name as your signature below. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
 
Travels by Charlotte | charlotte@travelsbycharlotte.com | 219-736-0228
 
[Name of Trip]






Thanks for your payment!

Office Only

{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }

{~ Payment_Block_Label}

{binding Group}
{binding Name} - {binding Description}{binding displayValue}
{{ Cognito.resources['payment-subtotal'] + ":" }}{binding displayValue}
{binding Name}:{binding displayValue}---
{{ Cognito.resources['payment-amount-due'] + ":" }} {binding displayValue}

Travels by Charlotte Trip Deposit

{{ 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}

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}
{ binding firstError.message }
Your Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Mobile Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Alternative Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

Untitled

Vacation Details

Departure Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Return Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Resort Name: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Please select your room type: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }

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}
{ binding firstError.message }
Date of Birth {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Gender {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Nearest Major Airport {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Allergies/Special Accommodations
Please select one or more choices {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Please provide any specific allergies or special accommodation needs below: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
Emergency Contact Person
Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Relationship {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Contact Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }
Do you currently have a passport with at least 2 blank pages and with an expiration date after (date six months after return date)? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

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. 

Passport Requirement Acknowledgement {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Untitled
Passport Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Nationality {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Country of Issue {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Issue Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Expiration Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
  • 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
Passport/Government ID Information & Status Acknowledgement {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }

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.
I have been advised of the option to purchase travel protection. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Would you like to accept or decline travel protection? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }

Credit Card Information

Name on Credit Card {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Billing Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Credit Card Type {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Credit Card Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
3 Digit Security Code {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Expiration Month {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Expiration Year {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }

Deposit Amount {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Travel Protection Amount {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Will you be the only one submitting payments for everyone on your reservation? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Information and Credit Card Information Acknowledgement {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

Terms and Conditions

{ binding firstError.message }
{ binding firstError.message }

Electronic Signature Agreement

Terms {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Please provide your name as your signature below. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }
 
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}
{ binding firstError.message }
Authorization Code {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Date Payment Submitted {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Beginning Balance {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Payment Amount {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Adjusted Balance {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Next Payment Due Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Note to Client {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }