CC Auth Form

Credit Card Authorization & Insurance Form

For your protection as well as ours, we will need the following authorization to charge your credit card, for your travel arrangements.

Please keep in mind the terms and conditions and cancellation policy on your reservation set by the Walt Disney Travel Company and any/all other travel vendor/supplier companies.

* Indicates required field

Your Disney Planner Travel Agent *

Name As It Appears On Card *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Type of Card *

Last 4 Digits of Credit Card ONLY (Your agent will contact you for complete card number over the phone) *

Expiration Date *

CVV Code (Last 3/4 digits on back of credit card) *

Amount Authorized To Be Charged With This Form *

Phone Number *

Email *

Travel Insurance: Please choose the following options. Choosing the option "No, I do not wish to purchase travel insurance" is your agreement to deny the purchase of travel insurance and will not hold Neverland Planning responsible for any losses/expenses due to travel situations that may arise. *Please note: There are fees associated with cancelling insurance once it has been purchased. However, it could possibly be added at a later time. Please speak with your Travel Professional at Neverland Planning for further details.

Travel Insurance- Opt-In/Out *

YES! - I DO want to purchase Travel Insurance at this time NO! - I DO NOT want to purchase Travel Insurance at this time

For cancellations any and all trip cancellations, I agree to the terms and conditions set forth by the travel supplier/vendor and Travel Agency. *

I have read, understood and agree to the above cancellation policy.

We make every effort to honor the package price quoted originally, however; under certain circumstances your price may be subject to increase prior to full payment due to an increase in the cost for one or more of the travel components of your package. Prices will not increase after you make full payment, except for charges resulting from increases in government-imposed taxes or fees. By signing below, you expressly acknowledge your acceptance of these conditions applicable to your purchase and by submitting this form you have read and agreed to this being your signature by electronic transfer to Neverland Planning. Please note: Prices quoted are not guaranteed unless a deposit has been applied to your reservation.

I agree to all terms of service, including travel insurance, cancellations, disclosure and consent to authorize payment to Neverland Planning. *

Yes, I do agree No, I do not agree

Digital Signature: By typing my digital signature below, In lieu of my credit card imprint, I authorize Neverland Planning to charge my credit/debit card in the amount agreed upon between Neverland Planning and myself, for the purpose of paying for travel services, including air tickets, travel related charges and service fees. *

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