Ambiance Travel LLC
Credit Card Authorization Form
Please print this page and fax to : +1-866-762-2907
Or copy and email to: Nina@ambiancetc.com
Personal Information: Please PRINT names as they appear on your passport.
Name of Primary Traveler:__________________________________________________________ Date of Birth:____________
Name of 2nd Traveler:______________________________________________________________Date of Birth:____________
Name of 3rd Traveler:_______________________________________________________________Date of Birth:____________
Name of 4th Traveler:_______________________________________________________________Date of Birth:____________
Vacation/Holiday Description: This information can be found on your emailed quote.
Ship/Hotel Name:___________________________________ Date of Departure:______________ Length:_________________
Cabin/Room Category:________________ Preferred Location requested:_________________Other Notes:_______________
_______________________________________________________________________________________________________
Cruise/Hotel Pricing & Depositing information
Total Price per person 1st/2nd___________________ 3rd/4th__________________
Deposit Amount Due:_____________________ Date:___________________
Final Amount Due:_______________________ Date:___________________
Your final amount due will automatically be charged on the above due date. A reminder email will be sent one week
prior to the charge.
Air/Transfers/Insurance (These will be priced out via email for your approval prior to being charged to the card below)
Will you need a pre/post cruise stay? Yes_____ No______ Number of nights_____________
Transfers Needed: Yes ____ No_____ Ship Transfer______ Private Transfer________
Will you need airfare? Yes_____ No____
Airfare Departure City:________ Departure Date:________ Return Date:_____________
Coach______ Business_______ First Class________
Optional
Check here if you would like Travel Protection Insurance: [ ]
If you will be waiving insurance please check here: [ ]
Note: We STRONGLY recommend protecting your vacation,
baggage and medical emergency needs with a travel insurance policy
Billing Information:
Name of Card Holder:____________________________________________________________
(Must be a member of the traveling party)
Credit Card Type: (AMEX , MC, V, Disc) ______________________ Exp Date:_____/_____ Security Code:________
Card Number:_____________________________________________________________________________________
Billing Address:____________________________________________________________________________________
____________________________________________________________________________________
Billing Phone:______________________________________ Email:__________________________________________
I________________________________________ hereby authorize, Ambiance Travel, to charge my credit card directly to
(name on card)
the cruise line/hotel/airline/insurance/transfer companies stated to arrange the above reservations on my behalf and
understand that I am responsible for any cancellation/change penalties that I may incur if changes or cancellations are
made after deposit. I understand I am responsible for full payment on these reservations and will be provided a confirmation
detailing all charges before and after payments are made. I also understand that all charges will be made in US dollars and
that I am responsible for any extra fees or charges my credit card company may impose for handling the currency exchange
if applicable.
Signed:_____________________________________________________ Date:_______________________
.