Make a Payment – Vacations Land

AUTHORIZATION FORM

Cardholder's Name*

Name Last Name

Phone*

Package Name or Destination*

Email*

Travel Date*

How many passengers are traveling?*

Name of traveler*

Name Last Name

Passport number*

Date of Birth*

Name of second traveler*

Name Last Name

Passport number*

Date of Birth*

Name of third traveler

Name Last Name

Passport number*

Date of Birth*

Name of fourth traveler

Name Last Name

Passport number*

Date of Birth*

Name of fifth traveler

Name Last Name

Passport number*

Date of Birth*

Name of sixth traveler

Name Last Name

Passport number*

Date of Birth*

Name of seventh traveler

Name Last Name

Passport number*

Date of Birth*

Payment Details

Choose payment method*

If you are choosing bank transfer as a payment method, please use the below specified account details:

Acount number: 1591032337
ABA: 063107513
SWIFT: 121000248

Card Payment Authorization

Card Number*

Expiration Date*

Security Code*

Enter amount (USD)*

Please enter the billing address associated to this card

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

TRAVEL INSURANCE: We highly recommend purchasing travel insurance “cancellation for any reason”

To protect your trip investment. Would you like a travel insurance quote?*

YES

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