Credit Card Authorization Form

Passenger Information

 All names listed below must be your legal passport names.

 

Passenger 1




Date of Birth

Gender
MaleFemale

 

Passenger 2


Date of Birth

Gender
MaleFemale

 

Passenger 3


Date of Birth

Gender
MaleFemale

 

Passenger 4


Date of Birth

Gender
MaleFemale

 

Passenger 5


Date of Birth

Gender
MaleFemale

 

Hotel/ Cruise Information

Hotel / Ship Name

Arrival Date

Return Date

Room Category / Cabin Type

Wedding / Group Name (if applicable)

 

Payment Details

Which Payment Is this?

Who is Your Exquisite Vacations Agent?

Card Holder Name

Card Number

Expire Date

CVC

Address Line 1

Address Line 2

City

State

Zip Code

Country

Do You Want Travel Insurance
YesNo
*Please make sure to include the insurance premium amount with your initial deposit.

Payment 1

Payment 2

Payment 3

Payment 4

Payment 5

Comments

(Additional Guests, Children’s Names, Dates of Birth or Extra Info)

Terms and Conditions

If this is a debit card, you may have a daily limit on your card, so please advise your bank if your payment amount is more than your daily limit or your charges may decline.

By signing below and submitting my payment, I acknowledge I am the cardholder and authorize Exquisite Vacations Inc., and its Tour Wholesaler / Cruise Lines to charge the amount to my credit card. I accept the charges described herein and understand that should my travel plans change, and I did not purchase travel insurance, I may not be entitled to a full refund and that cancellation and or change fees may apply. If I purchased travel insurance, my cancellation penalties would be adjusted or waived, based on the terms of the policy purchased. Travel Insurance Premium are nonrefundable once purchased. I accept that Exquisite Vacations Inc, its travel tour wholesalers /cruise lines and its independent agent are acting fully upon my direction and that I will not hold them responsible for acts beyond their immediate control as it relates to this charge and that I will make payment according to the terms of my agreement with the credit card company. Please note all payments are in US (USD) Dollars.

I agree to the terms and conditions listed above provided by Exquisite Vacations INC