Credit Card Authorization / Payment Form

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Step 1: Trip Details

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Travel Event:
Notes To Agent:
(Bride/Groom name, honeymoon description, vacation destination, other info to help your agent book your trip)
Next

Step 2: Credit Card Details

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In lieu of my credit card imprint, I hereby authorize Romance Travel Group to charge my credit card the amount below:
In lieu of name sign off (card holder name):
Credit Card Type:
Name On Card:
Credit Card #:
Expiration Date:
v
/
v
Security Code:
Billing Address:
Billing City:
Billing State:
v
Billing Zip Code:
Phone Number Of Card Holder:
Email Address Of Card Holder:
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Step 3: Payment Amounts

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The final payment date is listed in your quote or on the wedding website. Please be sure to have your trip paid in full before the final payment date. We can process 1 payment per month until the final payment date. Payments will be made on or after your specified date.
Payment Amount #1
on
v
Payment Amount #2
on
v
Payment Amount #3
on
v
Payment Amount #4
on
v
Payment Amount #5
on
v
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Step 4: Credit Card Authorization

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By initialing below, I
authorize Romance Travel Group to make the requested payment on my behalf. I accept that Romance Travel Group acts as a sales agent for travel Suppliers and is acting fully upon my direction. I will not hold Romance Travel Group responsible for acts or omissions of the Suppliers or their failure to provide services or adhere to their own schedules. I acknowledge that I have read and accept the Terms & Conditions.
Please Supply Initials:
I Agree - Submit Payment

Step 5: Thank you!

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Credit Card Authorization / Payment Form - Successful

Thank you for submitting your Credit Card Authorization Form.

A notification has gone to your travel agent and a email confirmation number has been sent to the card holder's email address. Your travel agent will review your request and confirm pricing and availability. If there are any discrepancies, your travel agent will contact you before making the reservation.