Payment Payment Form Select Type of Payment Initial Payment Other Payment Final Payment Please provide each traveler’s name EXACTLY as it appears in their passport and date of birth. How many passengers? * 1 2 3 4 5 6 7 8 9 10 Name Date of Birth Do you have a valid passport? Yes No Gender on passport or government ID? Female Male Undisclosed Passport Expiration Date Name Date of Birth Do you have a valid passport? Yes No Gender on passport or government ID? Female Male Undisclosed Passport Expiration Date Name Date of Birth Do you have a valid passport? Yes No Gender on passport or government ID? Female Male Undisclosed Passport Expiration Date Name Date of Birth Do you have a valid passport? Yes No Gender on passport or government ID? Female Male Undisclosed Passport Expiration Date Name Date of Birth Do you have a valid passport? Yes No Gender on passport or government ID? Female Male Undisclosed Passport Expiration Date Name Date of Birth Do you have a valid passport? Yes No Gender on passport or government ID? Female Male Undisclosed Passport Expiration Date Name Date of Birth Do you have a valid passport? Yes No Gender on passport or government ID? Female Male Undisclosed Passport Expiration Date Name Date of Birth Do you have a valid passport? Yes No Gender on passport or government ID? Female Male Undisclosed Passport Expiration Date Name Date of Birth Do you have a valid passport? Yes No Gender on passport or government ID? Female Male Undisclosed Passport Expiration Date Name Date of Birth Do you have a valid passport? Yes No Gender on passport or government ID? Female Male Undisclosed Passport Expiration Date Confirm Dates of Travel Departing * Returning * Package Information Are you a Destination Wedding Guest or Group Member? * No Yes Please give the name of the wedding couple, or group name, if "yes". Please remember to select your Travel advisor from the drop box below. Name of Destination Wedding Couple or Group You Are Traveling With? Name of destination wedding couple or group name? Please use this Drop Down Menu to select the Travel Advisor working with you : * Unsure Melinda H. Neil H. Donnie T. Stacey A. Anna C. Mandy Z. Leslie S. Adam W. Renee W. In order to avoid payment delays you must select the advisor working with the group or wedding you are attending, or the advisor assisting you. Confirmation Number If unsure, please leave blank. Payment Amount * Billing Information Name * Street Address * Street Address Line 2 City * State / Province / Region * Zip / Postal Code * Country * Email Address * Phone Number * Credit Card Information Credit Card Company * VISA Discover American Express Master Card Credit Card Number * Expiration Month * Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Expiration Year * 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 Security Code * Insurance Travel insurance is not automatically included in your package and can be priced for you by your Dreams and Destinations Travel Consultant. Cancel for any reason insurance, if available, must be purchased with deposit. Catastrophic insurance options can be added after deposit, but are not cancel for any reason. Insurance is highly recommended as travel suppliers, airlines and resorts often charge fees for trip change/cancellation after payment has been made. Dreams and Destinations Travel Agency is not responsible for penalties or fees should you change or cancel your trip. The cost of insurance is nonrefundable and insurance policies are non-transferable. Are you purchasing travel insurance? * Yes No If no, please initial Additional Comments? Special instructions, type of accommodations etc. * Signature (Use finger or mouse to sign) * Clear By submitting, you certify that you are the cardholder and are authorizing Dreams and Destinations, Inc. or its chosen Tour Operator/Supplier/Cruise Line to charge the listed amount to the credit card. You certify that you have verified that all information contained in the confirmation you received is accurate. You also certify you have read the Terms & Conditions and the appropriate Travel Protection Plan details. Cancellation penalties may apply. Insurance is not refundable. This charge will be manually applied by your Dreams and Destinations travel professional to your reservation. If there are any issues, your agent will notify you. Please note, depending on the supplier used, that you may not see a charge from Dreams and Destinations on your credit card statement; the charge may come from our supplier and/or the airline directly. Payment may take 3-5 business days to fully process and be reflected on your statement. I authorize Dreams and Destinations, Inc to use the above information to charge my credit card the stated amount. Terms and Conditions * I Agree to the Terms
