EmailMe Form - Tanya's South Africa birthday celebration

Today's Date *

MM / DD / YYYY

Your Name *

First Last

Email Address *

Phone *

### - ### - ####

Please describe the travel services for which you are paying. *

(Deposit, travel insurance, etc.)

Do you understand your final payment is due on or before October 14, 2025? *

Yes, I understand.

Do you understand and accept the pricing, itinerary and deadlines outlined in the travel quote provided by Geaux Journey Travel Group? *

Yes, I understand and accept.

Do you understand that all payments submitted to Geaux Journey Travel Group and its travel suppliers are non-refundable? *

Yes, I understand.

Do you give Geaux Journey Travel Group permission to make payments directly to travel suppliers on your behalf? *

Yes

What payment amount do you authorize? *

$ Dollars . Cents

Cardholder Name *

First Last

Card Type *

VISA

Mastercard

American Express

Discover

Billing Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Card Number *

Card Expiration Date *

Security Code *

(Code found on back of your card - typically 3 digits.)

Acceptance of Supplier Terms and Conditions *

I understand and accept the terms and conditions of the travel supplier (Goway).

Terms and Conditions

Acceptance of Geaux Journey Terms and Conditions *

I understand and accept the terms and conditions of Geaux Journey Travel Group.

Terms and Conditions

Authorization *

I hearby authorize Chantrice Banks of Geaux Journey Travel Group to charge the indicated credit card listed above for the travel services stated above. I guarantee and warrant that I am the legal cardholder for this credit/debit card.

Signature *

Clear