Tracy Bernier | Love the Mouse Travel

Lead Name on Reservation*

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Confirmation # (If Available)

This number would have been previously provided to you by your travel agent.

Destination*

If "Other", list your destination

Check-In Date*

Check-Out Date*

Billing Address*

Street Address Address Line 2 City State ZIP Code

Email*

Phone*

Name on Credit Card

First Last

Credit Card Type*

Credit Card Number*

Credit Card Security Number*

Credit Card Expiration Date*

Amount Authorized to Charge*

The amount that you would like charged to this card. If using multiple cards, please fill out a separate form for each card.

Vacation Insurance

Love The Mouse Travel believes that your upcoming trip is a significant investment that you should protect. For this reason, we suggest that you purchase a Vacation Protection Plan. Vacation insurance covers you and your family for certain unexpected circumstances. This vacation insurance plan continues to offer great benefits covering many emergency and unexpected situations prior to and during your vacation. Your travel consultant can provide you with more information regarding the coverage and benefits the plan provides. Ask you travel agent for current pricing.

Vacation Insurance Authorization*

I AUTHORIZE the purchase of a Vacation Protection Plan for my upcoming Disney vacation. I understand that the cost of vacation insurance is non-refundable should I cancel or interrupt my travel.
I DECLINE the purchase of a Vacation Protection Plan. I am aware of the cancellation penalties associated with my trip, as explained to me by my agent. By choosing to decline, I understand that I assume financial responsibility for any loss associated with my travel arrangements. Neither Love The Mouse Travel nor my agent are liable for my penalties due to my decision to decline this insurance.

Authorization for future use*

YES, keep this card on file for deposit, final payment, and dining/incidentals
YES, keep this card on file for future payments (include payment schedule in the comments below)
YES, keep this card on file for future payments (include payment schedule in the comments below), AND the final payment if I cannot be reached when my final payment is due.
NO, do not keep this card on file, this is for one-time use.

Additional Comments

Include any special requests, payment schedules, or other needs here.

Signature

Submit text*

By clicking submit, I acknowledge that Love the Mouse Travel will make payment on my behalf in the amount authorized above for the aforementioned vacation. By clicking submit, payment has been authorized to be made and is not made immediately.