EmailMe Form - Latitudes Travel LLC - Credit Card Authorization

Latitudes Travel LLC - Credit Card Authorization

This form is required. It verifies that you, the card holder, have given permission to Latitudes Travel LLC and its agents to process payments for your travel, excursions, transfers and other items related to your desired travel plans. This form is design with security measures in place to protect your information.
This form is required and is part of Latitudes Travel's efforts to fight credit card fraud and is also protection for you, the consumer, and Latitudes Travel LLC.

Destination of Trip & Reason for Travel *
As an example ---
Iberostar Lindo, Rivera Maya, Mexico - Family Vacation
Princess Cruise, Eastern Caribbean - Honeymoon
Departure Date of Trip/Travel *
MM / DD / YYYY

Names and Birth dates of all persons traveling with you as show on required Official Government issued ID. Domestic Travel: Acceptable Forms of ID are Approved State Drivers License that meet the REAL ID requirements for domestic transportation and Birth Certificates for minors only. International Travel: All passenger must have a Passport. Furthermore All Passports must have an expiration date of at least 6 months later than the date of your return back to the USA.

	Name EXACTLY as Shown On ID	Date of Birth	Passport Expiration Date
Primary Traveler -
Additional Traveler # 1
Additional Traveler # 2
Additional Traveler # 3
Additional Traveler # 4
Additional Traveler # 5

Card Holder's Name *
First Last
Card Holders Home Phone No. *
### - ### - ####
Card Holders Cell Phone No. *
### - ### - ####
Do you receive text messages on this device?
Yes
No
Will you be able receive text messages during this trip?
Yes
No
If you are traveling internationally you may need to have an international data plan.
Card Holder's E-mail *
The address you wish to have receipts, replies and questions to be sent to.

Confirm E-mail
Do you receive this email account on your phone/device?
Yes
No
Will you be able receive email messages during this trip?
Yes
No
If you are traveling internationally you may need to have an international data plan.
Billing Address for this credit card. *

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

The billing address is where you receive the bill for this card.
Credit Card Information ( You may Change this at a Later Date )

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.
I have been informed of the cancellation policies for our travel services and have been made aware of the benefits of travel protection.
*** I have decided to: *
I choose to purchase the Travel Insurance offered to me.
I decline the option to protect my investment. I choose not to purchase any of the Travel Insurance options offered to me.
I defer Travel Insurance at this time. I understand that if I fail to purchase insurance at a later date, my investment is not protected. I also understand that purchasing insurance later may mean some coverages and options may not be available.
Latitudes Travel offers a variety of different Travel Insurance options both through certain travel providers as well as a third party independent option.
Levels of protection and benefits differ by policy and, in some cases, may depend on when you purchase the insurance in regards to when you book your vacation/travel package.
I understand the New 2016 FAA Rules regarding prohibited and or restricted Hazardous Materials Materials on Air flights.
I understand and agree to abide by these requirements.
Federal law forbids the carriage of certain hazardous materials, such as aerosols, fireworks, and flammable liquids, aboard the aircraft.
If you do not understand these restrictions, contact your Latitudes Concierge Agent, your Airline or go to http://www.faa.gov/about/initiatives/hazmat_safety.
Comments /Notes /
Special Requests
Authorization Confirmation

Enter Complete Name:
Last, First, Middle *
By entering this information, you confirm the information on this form to be true and hereby authorize Latitudes Travel LLC to charge the indicated credit card listed for the travel services stated above. Furthermore, I guarantee and warrant that I am the legal cardholder for this credit card and, in the case of a business or corporate card, I am permitted to use the card for these purposes.
Signature
Clear
If you don't have a touch screen/pad you can use your mouse to sign... Yeah we know it is really hard, just do your best !
Name of Person who Signed Above