EmailMe Form - Reservation & Credit Card Payment

Today's Date *

MM / DD / YYYY

Destination *

I would like to take this opportunity to highlight the passport policy for guests traveling internationally to Mexico and the Caribbean.

It is important to note, passports are required and must be valid for up to six months at time of arrival to your travel destination. Passport and visa information may be obtained by contacting the Travel Advisory Section of the U.S. State Department at (202) 647-5225 or by visiting the State Department website at http://www.state.gov/travel.

Cost Of Trip Per Person. Prices are based on double occupancy.
If one traveler cancels this price will increase. *

$ Dollars . Cents

Must Have all Roommates' information in order to reserve a room.

Departure Date Of Travel: *

MM / DD / YYYY

Return Date Of Travel: *

MM / DD / YYYY

Name of the hotel or resort requested *

Group Leaders Name

1st Adult Travelers Name- Exactly As It Appears On Your Passport. *

First Last

It is the TRAVELERS responsibility to complete the following form fully and accurately.
I have confirmed the accuracy of my name and date of birth listed above. I acknowledge if the information is incorrect, I may be denied boarding and/or assessed additional fees.

Date of Birth* *

MM / DD / YYYY

Please Check One: *

FEMALE

MALE

Country Of Citizenship *

USA

CANADA

Email *

Cell Phone Number *

### - ### - ####

2nd Travelers Name- Exactly as It Appears on Your Passport

First Last

It is the TRAVELERS responsibility to complete the following form fully and accurately.
I have confirmed the accuracy of my name and date of birth listed above. I acknowledge if the information is incorrect, I may be denied boarding and/or assessed additional fees.

Date of Birth

MM / DD / YYYY

Pleae Check One:

FEMALE

MALE

Country Of Citizenship*

USA

CANADA

Email Address If you would like to receive an Email Confirmation.

Cell Phone Number

### - ### - ####

3nd Travelers Name- Exactly as It Appears on Your Passport

First Last

It is the TRAVELERS responsibility to complete the following form fully and accurately.
I have confirmed the accuracy of my name and date of birth listed above. I acknowledge if the information is incorrect, I may be denied boarding and/or assessed additional fees.

Date of Birth

MM / DD / YYYY

Pleae Check One:

FEMALE

MALE

Country Of Citizenship*

USA

CANADA

Email Address If you would like to receive an Email Confirmation.

Cell Phone Number

### - ### - ####

Please Type your Name to ACCEPT CANCELLATION TRAVEL PROTECTION

Yes, I want Travel Insurance and would like to add the cost to my deposit amount.

I ACCEPT TRAVEL PROTECTION
I understand that if I elect to accept Travel Insurance my deposit will increase, and I also understand that the cost of travel insurance is non-refundable .

Please Type your Name to ACCEPT DURING TRAVEL PROTECTION

Yes, I want Travel Insurance and would like to add the cost to my deposit amount.

I ACCEPT TRAVEL PROTECTION
I understand that if I elect to accept Travel Insurance my deposit will increase, and I also understand that the cost of travel insurance is non-refundable .

Please Type your Name to DECLINE ALL TRAVEL PROTECTION.

NO.. I Do Not want It.

I understand that if I elect to decline Travel Insurance I am responsible for any fees and all out-of-pocket expenses that may occur. I will also make my own provisions in the event of an emergency while I'm away if I elected to forgo travel insurance.

I DECLINE TRAVEL INSURANCE

Name as It Appears on Your Credit Card *

First Middle Last

Credit Card Account Type: *

Visa

MasterCard

AMEX

Discover

CVV (3 digit number on back of Visa/MC, 4 digits on front of AMEX *

Amount Authorized To Be Charged *

$ Dollars . Cents

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. *

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.

Credit Card Billing Address *

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

By submitting this form (You The Traveler) consent and agree to all terms and conditions listed below,

Charges for your vacation 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 are authorized to use this credit / debit card and that you 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, you the traveler, 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 travel, understand that if you elect to decline CANCELLATION TRAVEL PROTECTION You the traveler, are responsible for any cancellation penalties and all out-of-pocket expenses that may occur. You the Traveler, will also make your own provisions in the event of an emergency while you are away if you elected to forgo DURING TRAVEL PROTECTION INSURANCE You the Traveler, also understand that the cost of travel insurance is non-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. Traveler assumes complete and full responsibility for, 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, the travelers voluntarily assumes all risks involved in such travel, whether expected or unexpected. Traveler is hereby warned of such risks, and is advised to obtain appropriate insurance coverage against them. Traveler's 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. *

I Accept the Terms and Conditions and I authorize Louise Evans, My Escape Vacation LLC on my behalf to charge the amount listed 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. *

Please Type Your Name Below.

Passports are required to travel and fly Internationally.
Passports expiration date must be at least 6 months after your return date. *

Signature *

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