EmailMeForm
Payment Only Credit Card Authorization Form
Dear Valued Client,
A Passport (or) a Certified Birth Certificate is required to cruise from the USA returning back to the USA. Passports expiration date must be at least 6 months after your return date.
Reminder, If you taking a cruise from the USA and do not have a Passport or A Certified Birth Certificate along with a state ID or Driver License, You will be denied boarding and/or assessed additional fees.
To take a cruise that requires an international flight, You must have a Passport. A Passport is required to fly Internationally.
Please complete this form when making a payment to an existing reservation and to authorize a charge to your credit card.
All submitted payment and information is secure, properly protected, and used exclusively for your upcoming vacation.
My Escape Vacation, LLC
Vacation / Cruise Planner /Groups Specialist
b: 708-441-4497
h: Mon. - Fri. 9am -5pm (CST) Closed Sat. & Sun.
Thank you for your business and enjoy your day!
Today's Date
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Email
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Email
Dear Valued Travel Customer, this form authorizes My Escape Vacation LLC to make charges to your credit card for travel related services. The purpose of the form is to protect you, the card holder, from fraudulent use of your credit card.
This is permission for a single transaction and does not provide authorization for any additional unrelated debits or credits to your account.
Make A Payment For the Following Reservations.
Your Booking or Reservation numbers can be found on your email confirmation.
1st Booking or Reservation Number
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Please Check One:
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Carnival Cruise Lines
Royal Caribbean Cruise Lines
Norwegian Cruise lines
Air and Hotel
Hotel Only
Amount Authorized To Be Charged
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$
Dollars
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Cents
2nd Booking or Reservation Number.
Please Check One:
Carnival Cruise Lines
Royal Caribbean Cruise Lines
Norwegian Cruise lines
Air and Hotel
Hotel Only
Amount Authorized To Be Charged
$
Dollars
.
Cents
3rd Booking or Reservation Number.
Please Check One:
Carnival Cruise Lines
Royal Caribbean Cruise Lines
Norwegian Cruise lines
Air and Hotel
Hotel Only
Amount Authorized To Be Charged
$
Dollars
.
Cents
4th Booking or Reservation Number.
Please Check One:
Carnival Cruise Lines
Royal Caribbean Cruise Lines
Norwegian Cruise lines
Air and Hotel
Hotel Only
Amount Authorized To Be Charged
$
Dollars
.
Cents
Please notify your bank regarding large payment amounts so that they won't be declined.
Some banks have daily limited.
You must use a different form for each credit card.
Phone number
Total Amount To Be Authorized For The Above Reservations.
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$
Dollars
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Cents
Your Name As It Appears On Your Credit Card
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First
Middle
Last
Credit Card Account Type:
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Visa
MasterCard
AMEX
Discover
CVV (3 digit number on back of Visa/MC, 4 digits on front of AMEX
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Card Number
Expiration
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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.
Credit Card Billing Address
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Street Address
City
State / Province / Region
Postal / Zip Code
You Must Upload A Copy of the front of your Drivers License or State ID in order for me to charge to your credit card.
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Add File
If you are not traveling and are paying for this vacation for someone please upload a copy of the front of your credit card along with your drivers licence.
By submitting this form (You The Traveler/Credit Card Holder) consent and agree to all terms and conditions listed below,
Terms and Conditions:
To complete your transaction and confirm your arrangements and your submission of this authorization form requires your signature.
Charges are payable ONLY to the hotel, resort, tour operator, cruise line or other travel supplier designated by the above entity. You the Traveler, certify that You the Traveler are authorized to use this credit / debit card and that You the Traveler, are able to make charges using this credit / debit card .You the Traveler understand that in the event of cancellation all refunds due will go back to the original form of payment.
You the Traveler will not dispute the payment with my credit card company as long as the transaction corresponds with the terms indicated above. This payment authorization is for the travel related services described above. By my submission of this form, I give authorization to My Escape Vacation LLC and the travel vendor being used to debit my credit / debit card for all amounts listed above ONLY. You the Traveler understand that in the event of cancellation all refunds due will go back to the original form of payment.
You the Traveler understand that if You the Traveler elect to decline Travel Insurance You the Traveler are responsible for any cancellation penalties and all out-of-pocket expenses that may occur. You The Traveler, will also make my own provisions in the event of an emergency while You The Traveler are away if You The Traveler, elected to forgo travel insurance. You The Traveler, also understand that the cost of travel insurance is not refundable.
You The Traveler, understand that passports are required for guests traveling internationally and to resorts in Mexico and the Caribbean also passports must be valid for up to six months at time of arrival to your travel destination.
DISCLAIMER OF LIABILITY - This travel agency, My Escape Vacation LLC, is acting only as an agent for suppliers in selling travel related services, or in accepting reservations or bookings for services that are not directly supplied by this travel agency (such as air and ground transportation, hotel accommodations, meals, tours, cruises, etc.). This travel agency, My Escape Vacation LLC therefore, shall not be responsibility for breach of contract or any intentional or careless actions or omissions on part of such suppliers, which result in any loss, damage, delay, or injury to you or your travel companions or group members. Unless the term "guaranteed" is specifically stated in writing on your ticket, invoice, or reservation itinerary, we do not guarantee any of such suppliers' rates, bookings, reservations, connections, scheduling, or handling of personal effects. This travel agency My Escape Vacation LLC, shall not be responsible for any injuries, damages, or losses caused to any traveler in connection with terrorist activities, social, or labor unrest, mechanical or construction failures or difficulties, diseases, local laws, climatic conditions, criminal acts or abnormal conditions or developments, or any other actions, omissions, or conditions outside the travel agent's control. You The Traveler, assumes complete and full responsibility and hereby releases this travel agency My Escape Vacation LLC from any duty of, checking and verifying any and all passport, visa, vaccination, or other entry requirements of each destination, and all safety or security conditions at such destinations, during the length of the proposed travel. For information concerning possible dangers at international destinations, contact the Travel Advisory Section of the U.S. State Department. For medical information, call the Public Health Service.. By embarking upon his/her travel, You the travelers, voluntarily assumes all risks involved in such travel, whether expected or unexpected. You The Traveler, is hereby warned of such risks, and is advised to obtain appropriate insurance coverage against them. You The Traveler, retention of tickets, reservations, or bookings after issuance shall constitute a consent to the above, and an agreement on his/her part to convey the contents hereto to his/her travel companions or group members.
Thank You For Using My Escape Vacation LLC.
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I Agree To All Terms And Conditions and I authorize My Escape Vacation LLC, to make charges to my credit card for travel related services.
Please Type Your Name Below.
This form authorizes Louise Evans /My Escape Vacation LLC to make charges to your credit card for travel related services. The purpose of the form is to protect you, the card holder, from fraudulent use of your credit card.
This is permission for a single transaction and does not provide authorization for any additional unrelated debits or credits to your account.
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Signature Required
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Clear
