Form

Card Authorization - This form is used to submit payment to me (Dawn Caitano) for your vacation. It is very importatnt that all answers be accurate. I will book your vacation once this completed form has been returned to me.

Terms & Conditions - If you are unsure of the Terms & Conditions that apply to your vacation, please contact me at 917-494-5771.

I have been provided with payment due dates. I agree to make all payments on or before the due dates. This card will be kept on file to make any future payments. If you need to make a payment using a different credit card I agree to fill out a new form for each card. Payments are not done in real time, This form will come to me and then I will have to manually apply payment. So by hitting submit does not mean the payment was applied at that time.

Name *

First Name Last Name

Birth Date

Month Day Year

Phone Number

- Area Code Phone Number

Confirmation or Reservation Number *

Apply Towards

Deposit Standard Payment Final / Last Payment

Name (if different from above)

Street Address *

City & State *

Zip Code *

Payment Type *

Amex Discover Disney Visa Visa Mastercard

Amount to Apply *

Number on Card *

Expiration Date *

Security Code *

E-mail *

Enter the message as it's shown *

Comments:

IMPORTANT, PLEASE READ:

Please fill out all of the information, Once I recieve your form your payment will be applied in a timely manner. Make sure to email me when you hit the submit button so I can pull your form. You will recieve a new confirmation copy with in 6 hours via email. If you do not get your confirmation with in one day please reach out to me so I can resend.

Please let this document serve as my authorization to charge my credit card for amounts agreed to by me in writing or orally with Dawn Caitano.

Independant Contractor with Destinations in Florida Travel & Pixiedust and Dream Vacations.

Florida Seller of Travel # ST36132 Destinations To Explore, Inc.

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Booking with Dawn Caitano