Please
fill out ALLof the
fields below completely. Print, sign and date
the form at the bottom and then FAX
this page to us at (856) 435-3399. You will receive an email
within one business day as your receipt.
Client
Information
Name:
Street
Address:
(This should be where you would like your documents sent.)
City:
State:
Zip:
E-Mail
Address:
Phone:
Type
of payment:
Confirmation
number:
(Use last name if none available)
Destination:
Your
agent at Circle Travel:
Insurance If you've already made your deposit payment, please
skip this step.
Are
you purchasing insurance?.....
.....Must
initial if waiving:
Insurance
is highly recommended, and cannot be added on AFTER
deposit paid. If insurance is waived, portions of package
price may be non-refundable; please ask for details.
If you are choosing insurance, please make sure to add the
insurance cost to your deposit amount below, if it is not
already included.
Payment
Information
Amount
of payment:
$
...Must
be in USD
Credit
card type:
.....Check
if check/debit card:
(If this is a check or debit card, please check with
your bank that you are not exceeding a daily spending limit on
the card)
Credit
card number:
(xxxx-xxxx-xxxx-xxxx)
(Please note: No third party credit cards accepted.)
Expiration date:.....
3 digit security code:
(on back of card after 16 digit CC#)
Name
of cardholder as it appears on card:
Billing
address of card (leave blank if same as above):
Street:
City/State/Zip:
Enter any notes or requests, such as smoking or non-smoking, bed,
view or floor preferences, special occasions, applicable frequent
flyer numbers, etc. in the spcae below.
By
submitting, you certify that you are the cardholder and are authorizing
Circle Travel or its chosen Tour Operator/Wholesaler to charge the
listed amount to the credit card. You certify that you have verified
that all information contained in the confirmation you received
is accurate. You also certify you have read the Terms
& Conditions. Cancellation penalties may apply. Insurance
is not refundable.
Please be aware that you will not see a charge from Circle Travel
on your credit card statement; the charge will come from the Wholesaler
(Travel Impressions or Disney Cruise Line, for example) and/or the
airline directly (USAir or Air Jamaica, for example.)
If paying by other method (money order or cashier's checkONLY), please complete, print & sign this form, and send
with payment via courier service (UPS, FedEx, Airborne, etc. - do
not use regular mail) to:
Circle Travel • 1265 Blackwood-Clementon Road • Clementon,
NJ 08021.
Payments
must be received no later than 5PM EST on the due date listed on
your confirmation, or will be considered late and rates/availability
may not be able to be guaranteed.
