EmailMe Form - Luxury Travel Boutique Payment Form

EmailMeForm

Cardholder Name *
First Middle Last Suffix
Cardholder's Email Address *
Cardholder's Contact Phone number *
### - ### - ####
Reservation Number(s): *
This number can be found on the confirmation or invoice provided. The Reservation Number may also be listed as the Booking Number or Invoice Number.

If you are submitting payment for more than one reservation number, please indicate the amount to be applied to each reservation - or indicate split payment evenly among reservations listed - in the "Additional Comments" box below.
Payment Information for Reservation Number(s) Specified Above
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.
Billing Address associated with credit card: *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Amount to be charged to credit card provided in USD: *
$ Dollars . Cents
Enter numbers only - no commas or spaces
Additional Comments:
I have reviewed the terms and conditions for the reservation(s) specified above, including all change and cancellation policies. I understand that if I choose to change or cancel the specified reservation(s) that penalties may apply including the full cost of the reservation as well as travel agency change and cancellation fees which may be assessed. For any future bookings associated with my vacation, I agree to review all change and cancellation policies prior to submitting payment. *
I agree
I am aware that travel requirements may be in effect for entry into the destination and/or return to the country of origin. I understand that failure or refusal to meet these requirements does not entitle me to a refund and/or additional compensation. *
I agree
https://travel.state.gov/content/travel/en/international-travel.html
https://www.iatatravelcentre.com/passport-visa-health-travel-document-requirements.htm
https://wwwnc.cdc.gov/travel/destinations/list
I have reviewed and agree to the terms and conditions of Luxury Travel Boutique, LLC which can be reviewed at https://experienceluxetravel.com/terms-and-conditions/ *
I agree
I certify that I am the cardholder of the card submitted. I am authorizing Luxury Travel Boutique, LLC or its chosen Tour Operator or Supplier to charge the listed amount to the credit card provided. I certify that I have verified that all information contained in the confirmation I received is accurate.

I understsand this charge will be manually applied by Luxury Travel Boutique to the reservation(s) indicated during normal business hours and the payment may take 2-3 business days. If expedited payment processing is needed to meet payment deadlines, it is my responsibility to notify Luxury Travel Boutique during normal business hours Monday - Friday 9AM-5PM EST. If I fail to submit payment by the due date indicated on my invoice, I will be responsible for any cancellation penalties or rebooking fees associated with my reservation. Luxury Travel Boutique is not liable for canceled reservations due to late payments.

I understand that charges will not appear on my credit card statement as Luxury Travel Boutique. Payment information is manually submitted directly to the tour operator or supplier. Please check your invoice for further details.

By submitting payment for my reservation, I understand that I am responsible for abiding to current and future travel requirements for entry into the destination that I am visiting as well as the return to my country of origin which may include but are not limited to vaccination, testing, travel insurance, quarantine or forms. I am aware that failure or refusal to meet these requirements does not entitle me to a refund and/or additional compensation and cancellation terms outlined in the reservation will apply.

By signing below, I acknowledge this payment is subject to the terms and conditions of the reservation(s) including but not limited to travel agency, tour operator, airline, hotel, cruise line and other features. Change and Cancellation penalties apply to all reservations. Travel protection is highly recommended to protect your investment and well being.

Signature of Cardholder: *
Clear

Payment Information for Reservation Number(s) Specified Above