Registration: Cuba Trip

Registration and Booking

Cuba Trip

First Name

Last Name

Phone

First and Last of traveler #1

Date of birth of traveler #1

First and Last of traveler #2

Date of birth of traveler #2

TRAVEL PURCHASE AUTHORIZATION

Thank you for your purchase. Just Travel And Explore, LLC partnered with host agency InteleTravel.com is pleased to confirm your travel arrangements. To complete your transaction and confirm your arrangements and participation in this trip, your signature on this authorization is required. This form is NOT required for electronic purchases you complete yourself on our website KevineMcMillan.InteleTravel.com, or its affiliates. Charges are payable ONLY to InteleTravel.com, or the hotel, resort, tour operator, cruise line, or other travel suppliers. Independent Travel Agents may not accept and process charges through other accounts, or accept checks, cash or other forms of payment. This does NOT include applicable agent fees/registration fees.

By completing the form below, you authorize Just Travel and Explore, LLC to charge your credit card any applicable agent/registration fees to secure booking and authorize chosen travel supplier to process trip deposits and payments.

Registration and booking/agent fee will reflect Just Travel and Explore, LLC on bank statements.

Credit Card

First Name

Last Name

Notes:

Deposits for this trip is $70 per person. Please note that deposits are non-refundable or non transferable, no exceptions.

Authorized Trip Deposit amount to be charged to card

Credit Card Number

Expiration Date

Security Code

Billing Address

Address

Address Line 1

Address Line 2

City

Country

Select

State/Province

Select

Zip Code

I would like my card to be stored for future automatic payments.

Please sign on the line which applies

I have ACCEPTED and authorize the travel purchases above. I am aware that all deposits are NON REFUNDABLE and NON TRANSFERABLE, no exceptions.

Signature

To accept this contract, type your name below

Today's Date

Billing Address

Address Line 1

Address Line 2

City

Country

Select

State/Province

Select

Zip Code

Sub Total

$71.75

TOTAL

$71.75

Payment Method

Paypal
Stripe

Credit Card Type

Select

Name on Card

Credit Card Number

Expiration Date

Month

Year

Verification Number

*Please note a one time processing fee of $1.75.

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Registration: Cuba Trip

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