EmailMe Form - L & E Travels Client Information Form For Travel

L & E Travels Client Information Form For Travel

L & E Travels LLC
Dayton, Ohio 45406
(614)323-0608
letravelsllc@gmail.com

We appreciate your business. We will need the following information as authorization to charge your travel arrangements.

Please enter traveler's names as they appear on driver's license (or birth certificate if a minor), including middle name or initial if applicable. If anyone has a frequent flyer number for the airline, a global traveler number, or a TSA pre-check number, please enter in the additional comments box at the bottom of the form.

Thank you!

Traveler 1 *
First Middle Last
Date of Birth
MM / DD / YYYY
Traveler 2
First Middle Last
Date of Birth
MM / DD / YYYY
Traveler 3
First Middle Last
Date of Birth
MM / DD / YYYY
Traveler 4
First Middle Last
Date of Birth
MM / DD / YYYY
Phone *
### - ### - ####
Email *
email@email.com
Cardholder's Name *
First Last
Billing Address *

Street Address City State / Province / Region Postal / Zip Code
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.
Amount to charge *
$ Dollars . Cents
Please check *
I have reviewed the names, dates, times, and reservations made on my behalf by L & E TRAVELS and I agree that they are correct and accurate.
Cancellation Penalties: I understand the airline rules regarding changes and cancellations.
I am the owner of this credit card and I agree to pay the amount shown. I agree not to dispute this charge with my credit card company. Please initial below *
Trip Insurance Notification: Trip insurance is strongly recommended to protect clients from certain situations that could cause this trip to be cancelled, interrupted, and/or delayed resulting in a loss of time and money. Please choose one: *
I choose not to protect my investment with trip insurance. I understand that the L & E TRAVELS will be held free of any claims made as part of this transaction.
I accept trip insurance. I agree to all of the terms and conditions of the insurance program. I understand the coverage provided by the insurance company and will direct questions to the insurance provider.
Additional comments