EmailMe Form - Credit Card Authorization Form

Dropdown *
Traveler Full Legal Name *
First Last
Legal name as on government issued identification.
Billing Address *

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

Please enter the address that is on file with the card.
Cardholder Phone Number *
### - ### - ####
Email *
This will be used for mailing any electronic documents/itineraries.

Confirm
Trip Destination *
Please enter in your desired destination. If cruising with multiple destinations just put one location. ex: Bahamas
Is this a Group Trip?
Yes
No
If yes, then please name your Group Organizer
Please enter the name of the group organizer if unsure then put n/a.
Please List All Travelers Legal Names and Full Birthdate's to be included on this reservation (same room).
Full Legal Names Birthdate MM/DD/YY format of all passengers residing in the same room.
Payment Details
Please provide payment details below
Authorized Amount *
$ Dollars . Cents
MINIMUM DEPOSIT is amount required today to initiate reservation. (The date of travel, number of paying guests and supplier terms will be factered in computing required deposit amounts.) This amount is included in Total Package Quote provided in Email. You MUST pay the balance in full prior to Final Due Date or if booking within 60 Days of Traveling.
Credit Card

Card Number

Protected in vault Data collected via fields that have our security seal are encrypted and stored with the highest global security standard — PCI compliance. Your data is absolutely safe in Vault.
Authorization of Charges *
I do authorize
As named Cardholder; I Authorize: Go Far VIP Travel to immediately charge my credit card the above amount, as needed to complete the reserved Travel Package account for the Primary Traveler listed above.
Authorization of Future Payments *
I Authorize my Future Payments
I want to use a different card for Future Payments
I will authorize By EMAIL, all future payments due towards Total Package Cost, to be charged to the above credit card with the same terms as disclosed.
Required *
ACCEPT: I have selected to PURCHASE Travel Protection Insurance as offered by Go Far VIP Travel. I have reviewed the Policy Coverage and accept that the policy meets my desired protection plus I understand all insurance premiums are non-refund
DECLINE**: I acknowledge that I have received Travel Insurance information and quote; I am WAIVING access to these coverage provisions by DECLINING to purchase the travel insurance offered by Go Far VIP Travel for my travel plans.
**If DECLINING: note that you may be able to purchase limited coverage up to 48 hours prior to travel. Ask your agent for restrictive details. Go Far VIP Travel will not be held liable for any financial losses incurred from failure to purchase insurance coverage. Insurance Premiums are always non-refundable.
Reservations: *
I hereby authorize Go Far VIP Travel and its travel agents to serve as my booking representative and provide my credit card payment information and any other personal information listed on my itinerary that may be necessary to make my reservations.
The payment and personal information I have provided, as reflected on the itinerary, is true and accurate. I acknowledge that the booking made by my travel professional with Go Far VIP Travel and/or its agents is free from errors. The check in and check out date, resort where applicable, room category where applicable, ticket details where applicable, itinerary where applicable, and guest(s) details (name, gender, and other details) are correct.
Payments & Changes *
I understand and agree that I am responsible for all payments for my travel reservations as they become due, and I will make these payments in a timely manner.
I also understand and agree that any cancellation, modification, or alteration I elect to make to my travel reservations may result in change fees, penalties, and/or related additional costs. I acknowledge that I am responsible for any such fees that I elect to make to my travel reservations.
Release of Liability *
I understand that by submitting or booking and/or paying for my reservation I hereby release and agree to hold SP Travel, LLC. D.B.A Go Far VIP Travel, its employees, agents, and owners from any liability or claim.
I, my heirs, or any personal representatives may have with respect to any bodily injury, illness, death, medical treatment, or damages that may arise from, or in connection to, any services received from SP Travel, LLC. D.B.A Go Far VIP Travel.
Cancellation Policies *
I agree that should I cancel and did not purchase trip protection that I forfeit all money paid. I ALSO agree that there is a $35 per person cancellation fee that Go Far VIP Travel imposes for cancelled reservations that must be paid.
Your trip will not be cancelled until funds are received for the trip cancellation fee imposed by Go Far VIP Travel.

Payment Details