VIP Leisure Travel
Vacation Deposits & Payments
Are all passengers US Citizens?
This payment is a ...
Final / Last Payment
Name on Card (if different from above)
Credit Card Number
Billing Street Address
Billing City & State
Billing Zip Code
Amount to Charge
Exp. Date ex: 01/15
Debit Card, Credit Card Authorization
Authorization is required to charge your credit card or debit card. Your completion of this authorization form helps us to protect you, our valued clients, from credit card fraud. All information on this form is kept strictly confidential. The "Yes" click below is representative of an Electronic Signature. This is a secured site.
YES : Credit Card / Debit Card Authorization is Approved
NO : Credit Card / Debit Card Authorization is Not Approved
Yes, I elect to purchase travel insurance
No, I do not elect to purchase travel insurance and waive my rights to any claims
Should be Empty: