EmailMeForm
Credit Card Authorization Form (2024)
Payments are NOT processed automatically. Please allow up to 24-48 business hours for your payment to be processed.
Any payments made after 9PM are subject to be processed the next the business day.
**Please do not submit payments with locked cards.**
Traveler Full Legal Name
*
First
Last
Legal name as on government issued identification.
Date of Birth
MM
/
DD
/
YYYY
Please enter Date of Birth for Primary Passenger
Billing Address
*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Please enter the address that is on file with the card. (Do not forget to add your zipcode)
Cardholder Phone Number
*
###
-
###
-
####
Email
*
This will be used for mailing any electronic documents/itineraries.
Booking Number
*
PAYMENTS WILL NOT BE PROCESSED IF THERE IS NOT A CONFIRMATION NUMBER PROVIDED. YOUR PAYMENT CONFIRMATION IS NOT YOUR AIRLINE RECORD LOCATOR NOR YOUR EMAIL ADDRESS.
PLEASE REVIEW YOUR "OFFICIALLY BOOKED" EMAIL TO LOCATE YOUR PAYMENT CONFIRMATION NUMBER.
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.
Payment Details
Please provide payment details below
Authorized Amount
*
$
Dollars
.
Cents
Credit Card
*
Card Number
Expiration
MM
/
YY
CVV
What is this?
3 or 4 digit number printed on the back/front of your credit card
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.
Comments:
Please notate if or how the payment should be applied to the booking (if being applied separately amongst booking mates).
Authorization of Charges
*
I do authorize
As named Cardholder; I Authorize: The Experience By Sommer Monike/Agent- Sommer Monike to immediately charge my credit card the above amount, as needed to complete the reserved Travel Package account for the Traveler listed above.
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 administration fee that The Experience By Sommer Monike imposes that is also nonrefundable.
Your trip will not be cancelled until you have contacted The Experience By Sommer Monike in writing of your cancellation request.
Signature
*
Clear
