PLEASE NOTE THAT OUR SYSTEM WILL NOT ACCEPT DEBIT CARDS.
Please complete the Credit Card Payment Form below and fax back to 1-425-487-2561.

• THE CARDHOLDER MUST SIGN THIS FORM IN ORDER FOR THE CHARGE TO BE PROCESSED.
• THE CARDHOLDER MUST BE ONE OF THE PASSENGERS.
• I HAVE READ AND I UNDERSTAND THE TERMS AND CONDITIONS.
• I HAVE REVIEWED MY ITINERARY AND I VERIFY THAT ALL INFORMATION IS ACCURATE.
• IF ANY INFORMATION IS INACCURATE, INCLUDING BUT NOT LIMITED TO PASSPORT NAMES, TRAVEL DATES & CITY OF DEPARTURE, PLEASE CALL 1-888-937-8474 PRIOR TO SUBMITTING THIS FORM.
• I UNDERSTAND THAT PENALTIES, TRAVEL DELAYS OR CANCELATIONS MAY APPLY SHOULD ANY CORRECTIONS NEED TO BE MADE.
• I UNDERSTAND IT IS MY RESPONSIBILITY TO OBTAIN THE NECESSARY DOCUMENTS FOR TRAVEL INCLUDING PASSPORTS AND VISAS.
• BY SIGNING BELOW I AGREE TO ADHERE TO THE TERMS & CONDITIONS OF THIS TRANSACTION.

Booking Number: ________________

Card Holder Name______________________________________

Card Holder Billing Address- Street______________________________________

CITY__________________________________ STATE___________ ZIP_____________

Credit Card #_________________________________________ Exp_____

Credit Card Identification Number_______________
(This is located on the front or back of the credit card)

Visa, Mastercard, Discover & American Express Credit Cards gladly accepted Debit Cards are not accepted

I authorize $__________ (enter amount) to be charged on my credit card.

Card Holders Signature______________________________________Date___________

I have been advised of and chosen to ___ACCEPT ___DECLINE Virgin Vacations travel insurance. Please note that if you did not book insurance when you submitted your request an additional amount will be due should you wish to add it to your reservation.