COASTAL CRUISE & TRAVEL, LLC
Deposit - New Reservation
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DID YOU RECEIVE A QUOTATION FOR VACATION PROTECTION/TRAVEL INSURANCE?
Cardholder Name(as appears on card)
Authorized Payment Amount ($)
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Credit Card Number
Credit Card CVV
CVV is an anti-fraud security feature to help verify that you are in possession of your credit card. For Visa/Mastercard, the three-digit CVV number is printed on the signature panel on the back of the card immediately after the card's account number. For American Express, the four-digit CVV number is printed on the front of the card above the card account number.
Credit Card Expiry Month
Credit Card Expiry Year
Address where credit card bill is received.
Billing Postal Code
Would you like to keep this credit card on file for future payments? *****NOTE No payments will be processed without your prior authorization*****
Select Your Preference
YES. Please keep this credit card on file.
NO. I prefer to complete this form for each payment.
Comments or Special Instructions
I have read and agree to the terms and conditions in my quote.
--Yes and I agree.
Are you purchasing Vacation Protection/Travel Insurance?
--No. I decline the offer to purchase travel insurance/vacation protection. I understand that I am solely responsible for any cancellation penalties and out-of-pocket expenses incurred. I will also make my own separate travel, medical and any other provisions in the event of an emergency while I am traveling. I also understand that I am not protected from loss in the event of any travel vendor, travel supplier or any travel-related operator default. This waiver confirms that I voluntarily decline travel insurance/vacation protection insurance for the reservation/booking number provided above. I understand I am solely liable for all airline fees, supplier fees and agency fees that may apply, and I hereby release Coastal Cruise & Travel, LLC from any and all liability related to the reservation included herein.
I authorize Coastal Cruise & Travel, LLC to charge the credit card listed above for the payment as indicated.
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Coastal Cruise & Travel, LLC