Payment Plan Authorization

Payment Plan Request

To establish your payment plan please enter your information below.
Name *

First Name Last Name
Email *
example@example.com
Phone Number *
Please enter a valid phone number.
Trip Destination *
Trip Date *
Date to charge first payment *

Month Day Year
Date
Date to charge last payment *

Month Day Year
Date
Please charge my card *

Once a month Once a week Every other week Other
Each designated period, please charge my card this amount: *
Type in the amount you wish to pay.
The last four numbers of the credit card to apply the charges are: *
This must be a card we have on file for you. If you wish to use a different card, please use the link below to add another card.
Should you prefer to use a card we do not have on file for you, please go here to add it. You will need to Confirmation NUmber that is listed on the upper right corner of your Confirmation-Receipt.
Comments (Please do not include your credit card information here.)
By submitting this form, you certify that you are the cardholder and are authorizing Ebony Vacations to charge the listed amounts to the credit card as indicated.

You certify that you have verified that all information contained in the confirmation you received is accurate. You certify that where indicated, payments/deposits may not be refundable.

This charge will be applied by Ebony Vacations to your reservation. If there are any issues, we will get back to you. Please note that you will see a charge from Ebony Vacations on your credit card statement. Payments may take 3-5 business days to fully process and be reflected on your statement.

I authorize Ebony Vacations to use the above information to charge my credit card the stated amount on the stated dates.

By adding your signature, you indicate that the above amounts and dates are correct, you authorize Ebony Vacation to charge your credit card for the specified amount on the specified dates, and you agree to the terms and conditions.
Signature

Clear
Please verify that you are human *
Should be Empty:

Payment Plan Request