MAKE A PAYMENT - Rare Diamonds Travel

PRIVATE TRIP TRAVEL AUTHORIZATION

Make A Payment On Your Trip

Trip Payment Authorization

Payment Information

Please answer the questions below so that we may meet your travel expectations.

Today’s Date

Travelers #1 Full Name (As it appears on your Credit Card)

Traveler’s Email Address

Travelers Contact Phone Number

Travelers FULL Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Travelers Date of Birth

Travel Date

Trip Destination

Payment Type

Payment Amount

Departure City Airport(s)

Card Type

Credit Card Number

Re-Enter Credit Card Number

Card Expiration Date

3 Digit CVV or 4 Digit CID Number

Billing Zip Code

Would you like to set up scheduled payments?

Yes, I would like to set up scheduled payments

No, I do not wish to have scheduled payments

Scheduled Payment(s) Specification: (List your payment amount(s) and desired withdrawal date(s))

Any Additional Information? (put any specifications of your payment here)

I certify that I am the authorized user of the above listed credit card. I am submitting this payment(s) and waiving my right to a charge back, stop payment, reverse, or recollection of any payment(s) already made. Rare Diamonds Travel reserves the right to collect any and all additional costs, fees, and expenses associated with a charge back, reversal, stop payment or recollection including and not limited to attorney fees

I am the authorized user of the above listed credit card

By initialing, you authorize Rare Diamonds Travel to submit the amount you indicated above towards your vacation. (Please initial below)

Payment Processing:
Please allow 24-48 hours for your payment to process.

PRIVATE TRIP TRAVEL AUTHORIZATION

Payment Information

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