Confirmation and Authorization Form
Name of Trip: i.e. Destination, Hotel, Ship or Tour Name, Group Name, etc.
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Cardholder First Name as Appears on Card
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Cardholder Last Name as Appears on Card
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Address (this is your address associated with your debit or credit card account billing statement)
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Address (continued)
City
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State
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Zip Code
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Country
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Phone
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Phone (secondary)
Your Email
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Last 4 digits of card
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Name as appears on card
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Please note: If you are using a VISA or MC Debit card, it will most likely have a daily spending limit. Your card may be declined if your purchase is higher than your daily limit, even if you have sufficient funds in your checking account. It is your responsibility as the purchaser to ensure that your daily limit is high enough to cover your purchase. If you are not certain, please contact your bank prior to submitting form. You can always ask your bank to increase your daily limit. A declined debit card or credit card transaction may incur a penalty fee of up to $25 per declined transaction from A Room With A View Travel. Please initial below that you have read and agree to this.
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Travel Insurance is strongly encouraged. Please indicate your choice below. Contact us first if you have not received a quote for your travel package.
Option 1 - Purchase Travel Insurance With Deposit. ** Option 2 - Purchase Travel Insurance WIth Final Payment. ** Option 3 - Decline Travel Insurance. ** Option 4 - Pre-Trip Penalty Waiver Only (Not available with every travel package) **Option 5 - Insurance already purchased
Travel Insurance - Select an Option
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Option 1 - Purchase Travel Insurance With Deposit (Most Recommended)
Option 2 - Purchase Travel Insurance With Final Payment
Option 3 - Decline Travel Insurance
Option 4 - Purchase Pre-Trip Penalty Waiver Only With Deposit (this is not travel insurance.)
Option 5 - Insurance previously purchased for this trip. (If submitting new form for final payment.)
Payment Amount for Deposit and/or Full Balance Due
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Payment Amount with Travel Insurance Included
Auto-Pay Option for Final Payment - By typing "Yes" in field, you are indicating that you would like to have our agency automatically process your balance due or final payment on the card noted on this form on or before final payment due date.
Travel Agent You're Working With
Comments/Questions - Please note any comments or questions here:
By clicking on the Submit button below I authorize A Room With A View - Cruise & Travel to charge the amount due for my travel reservation(s) as indicated above. I guarantee and warrant that I am the legal cardholder for this credit or debit card.
I have read over the travel supplier and travel agency terms and conditions (Consumer Disclosure Notice found on our web site under Client Forms) and reviewed the cancel and change penalties. I understand penalties will apply if the booking is changed or canceled. The travel products and services being purchased may be subject to additional surcharges, cost increases, and fees imposed by individual travel suppliers or government entities after the purchase date. I understand that I may be charged these post-purchase amounts for reasons varying from currency exchange fluctuations to fuel surcharges and new travel taxes. I consent to these post purchase price increases, and I authorize A Room With A View - Cruise & Travel, LLC to charge my credit card for these amounts due. By clicking on the submit button, I authorize A Room With A View - Cruise & Travel, LLC to charge the amount due for the travel reservation(s) noted above and agree to the travel supplier and A Room With A View - Cruise & Travel, LLC terms and conditions. Your credit card will not be automatically charged upon form submission. You are merely providing payment information and authorization and your payment will be processed manually by your travel consultant with the travel supplier for said travel reservation(s).
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