EmailMe Form - Booking & Deposit Payment Form

Trip / Group Name *
As written on quote
Today's Date
MM / DD / YYYY
Departure Date *
MM / DD / YYYY
Return Date
MM / DD / YYYY
Traveler #1 Full Name *
First Middle Last
Traveler # 1 Date of Birth *
MM / DD / YYYY
Traveler #1 Best Contact Number *
### - ### - ####
Traveler #1 Phone Type *
Home
Work
Cell
Traveler #1 Gender *
Female
Male
Traveler #1 Email *
Mailing Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Room Type / Name
Ex. Junior Suite Ocean View, Swimout
Bedding Type
Any Special needs travelers?
Yes
No
Do you want Vacation Travel Protection? *
If you would like travel insurance, please select “yes” for travel protection and we will provide a quote. Coverage cost may be due at the time of initial payment.
Traveler #2 Full Name
First Middle Last
Traveler #2 Date of Birth
MM / DD / YYYY
Traveler #2 Gender
Female
Male
Traveler #2 Email
Traveler #2 Best Contact Number
### - ### - ####
Traveler #2 Address

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

Complete if not same as traveler #1
Traveler #3 Full Name
First Middle Last
Traveler #3 Date of Birth
MM / DD / YYYY
Traveler #3 Gender
Female
Male
Traveler #3 Email
Traveler #3 Best Contact Number
### - ### - ####
Traveler #3 Address

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

Complete if not same as traveler #1
Traveler #4 Full Name
First Middle Last
Traveler #4 Date of Birth
MM / DD / YYYY
Traveler #4 Gender
Female
Male
Traveler #4 Email
Traveler #4 Best Contact Number
### - ### - ####
Traveler #4 Address

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

Complete if not same as traveler #1
Cardholder Name *
First MI Last
Payment Type *
Payment Amount *
$ Dollars . Cents
All payments are in USD ($)
Billing Address

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

Complete only if address is different from mailing address.
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.
Additional Information
Ex. Add any special request
Cardholder Signature *
Clear
In lieu of my credit card imprint, I, undersigned, hereby authorize OneStop Travel Planners or its affiliates to charge my credit card. You also certify you agree to the Terms & Conditions located at www.onestoptravelplanners.com. Cancellation penalties may apply. Insurance is not refundable.