Please sign and complete this form to authorize The Curated Travel Collection/ Ears of Experience, LLC to make a one-time debit to your credit card listed below.

By signing this form, you give us permission to debit your account for the amount indicated on or after the indicated date. This is permission for a single transaction only and does not provide authorization for any additional unrelated debits or credits to your account.

Please complete all field. You may cancel this authorization at any time by contacting us. This authorization will remain in effect until cancelled.

Client Information

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

List First and Last names of your travel party (including dates of birth). ***If provided already, simply enter N/A and skip this section. * *

Payment Information

Name on Card *

Credit Card Type *

Credit Card Number *

Expiration Date (mm/yy) *

CVV Code *

Amount of Payment *

Date of Payment * +

Description of Goods or Services *

Name of my CTC Travel Advisor *

Credit Card Authorization *

I authorize the above-named agent with The Curated Travel Collection to charge the credit card indicated in this authorization form according to the terms outlined above. This payment authorization is for the goods/services described above, for the amount indicated above only, and is valid for one time use only. I certify that I am an authorized user of this credit card and that I will not dispute the payment with my credit card company; so long as the transaction corresponds to the terms indicated in this form.

Future Transactions *

I understand that my credit card information will be saved to file for future transactions on my account.

This card may also be used for additional payments for items marked below, but only when written instruction to use the "card on file" for payment is given to Bethany Singleton with The Curated Travel Collection, parent company of Ears of Experience: *

Signature of Cardholder Required *

clear

Terms and Conditions of The Curated Travel Collection, LLC *

I have read and agree to The Curated Travel Collection LLC's Terms and Conditions.

FOR DISNEY CLIENTS ONLY
Please add your credit card information to your “My Disney Experience” account profile for Advance Dining Reservation bookings. The costs for these reservations will vary and you will be notified of the price before making any such reservation. These reservations can be seen in your My Disney Experience account after they are booked. Make sure to check your reservations in your account and make any changes or cancellations at least 2 hours in advance (for most dining reservations) to avoid unnecessary credit card charges. Keep in mind there are select dining locations that require 5 days or 24-hour notice for cancellations (such as dessert parties, dinner shows, and Victoria & Albert's).