Please sign and complete this form to authorize The Curated Travel Collection to make a one-time debit to your credit card listed below. This form does not charge your card. The vacation supplier will process your payment. Please allow 1 business day for processing.

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 *

Reservation Payment Type *

Trip Deposit

Planning Package

Final Payment

Misc Payment

Please enter all travelers legal names and birthdates in the box below. *

Would you like a travel protection plan quote for this vacation? *

Yes, please send me a no obligation quote.

Please purchase the travel protection plan we discussed in my vacation proposal.

I have already purchased travel insurance for my vacation.

No, I DECLINE a travel protection plan quote. I understand that declining travel insurance could result in the loss of my travel cost and/or require more money to correct the situation. I also acknowledge that without insurance, there may be no way to recoup any losses, costs or expenses incurred.

Payment Information

Name on Card *

Credit Card Type *

Type of Payment *

Credit Card Number *

Expiration Date (mm/yy) *

Security Code (3 or 4 digits) *

Is the above address the same as your billing address? *

Please enter your billing address for this card. *

Amount to be charged *

Date of payment * +

Description of goods and services *

Signature *

clear

My Curated Travel Collection® Travel Advisor is Aubrey Mulrooney. *

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.

Terms & Conditions *

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

Future Transactions: I understand and agree that my credit card information can be saved to file (secure & encrypted) for future transactions on my account. *

Yes

No

For Disney World and Disneyland 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 that dessert parties have a 1-day cancellation policy while dinner shows have a 48-hour cancellation policy.