Payment Authorization Form

Payment Authorization Form
Important: Please read carefully before continuing!

This form is required for EACH form of payment. If we are using more than one credit card, a new form will need to be filled out.

If you have more than 10 travelers, you will need to fill this out a second time for the remaining travelers.
Card Holder Information
I, First Name* Last Name* hereby authorize Hagan Hideaway Travel/Inteletravel or the travel supplier to charge my credit card below for the travel itinerary listed below:
For The TOTAL Amount Of $ (in USD)*
I understand that the total authorized amount may be processed in multiple transactions according to supplier billing schedules. Please put the TOTAL amount of your trip, NOT the deposit amount. If your trip is being booked separately on multiple sites (flights, hotel, car rental, insurance, etc.), your card will be charged in separate transactions.
Name as it appears on card*

First NameLast Name
Billing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number Associated with card *
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Itinerary
Destination*
Departure Date*

MonthDayYear
Return Date*

MonthDayYear
YesNo
U.S. MilitaryFirefighter/EMT/First ResponderAge 55+
Early Dining (typically 5pm - 5:45pm)Late Dining (typically 7:30pm - 8:15pm)Flexible (typically 5pm - 9pm)Whatever is available
Prepay GratuitiesPay Gratuities Onboard
Traveler Details
How many passengers are traveling in total?*
Please include yourself. Please only include those that you are paying for on this credit card.
- NOTE: Please write the name as it appears on your passport (for international travel) or other government issued identification.
- Name*
  
  PrefixFirst NameMiddle NameLast NameSuffix
- Date of Birth*
  
  MonthDayYear
  Date
- Gender*
  Required for airline and cruise line manifests to match travel identification.
- Phone Number*
  Please enter a valid phone number.Format: (000) 000-0000.
- Email*
  example@example.com
- Mailing Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Who are you rooming with?
  Please list all names that will share your room.
- Please provide your room category selection. Please refer to your quote for the correct room description.
  Example: Ocean View Suite-King Bed OR Garden View-2 Queen Beds OR Balcony Ocean View-King Bed
- Passport Information
- Yes, traveler has a valid passportPassport expired, must renewDo not have a passportPassport not required for this trip
- Passport Number
  Passport information may be provided later if you haven't received yours yet.
- Passport Expiration Date
  
  MonthDayYear
- Passport Issuance Date
  
  MonthDayYear
- Country of Issuance
- Country of Birth
- Additional Information
- TSA Precheck or Global Entry Numbers
- Loyalty Member Numbers/Frequent Flyer Numbers
- Emergency Contact
  Name, Phone Number, Address, and Relation
- NOTE: Please write the name as it appears on your passport (for international travel) or other government issued identification.
- Name*
  
  PrefixFirst NameMiddle NameLast NameSuffix
- Date of Birth*
  
  MonthDayYear
  Date
- Gender*
  Required for airline and cruise line manifests to match travel identification.
- Phone Number (If different than listed above)
  Please enter a valid phone numberFormat: (000) 000-0000.
- Email (If different than listed above)
  example@example.com
- Mailing Address (If different than listed above)
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Who are you rooming with? (If different than listed above)
  Please list all names that will share your room.
- Please provide your room category selection. Please refer to your quote for the correct room description. (If different than listed above)
  Example: Ocean View Suite-King Bed OR Garden View-2 Queen Beds OR Balcony Ocean View-King Bed
- Passport Information
- Yes, traveler has a valid passportPassport expired, must renewDo not have a passportPassport not required for this trip
- Passport Number
  Passport information may be provided later if you haven't received yours yet.
- Passport Expiration Date
  
  MonthDayYear
- Passport Issuance Date
  
  MonthDayYear
- Country of Issuance
- Country of Birth
- Additional Information
- TSA Precheck or Global Entry Numbers
- Loyalty Member Numbers/Frequent Flyer Numbers
- Emergency Contact (If different than listed above)
  Name, Phone Number, Address, and Relation
- NOTE: Please write the name as it appears on your passport (for international travel) or other government issued identification.
- Name*
  
  PrefixFirst NameMiddle NameLast NameSuffix
- Date of Birth*
  
  MonthDayYear
  Date
- Gender*
  Required for airline and cruise line manifests to match travel identification.
- Phone Number (If different than listed above)
  Format: (000) 000-0000.
- Email (If different than listed above)
- Mailing Address (If different than listed above)
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Who are you rooming with? (If different than listed above)
  Please list all names that will share your room.
- Please provide your room category selection. Please refer to your quote for the correct room description. (If different than listed above)
  Example: Ocean View Suite-King Bed OR Garden View-2 Queen Beds OR Balcony Ocean View-King Bed
- Yes, traveler has a valid passportPassport expired, must renewDo not have a passportPassport not required for this trip
- Passport Number
  Passport information may be provided later if you haven't received yours yet.
- Passport Expiration Date
  
  MonthDayYear
- Passport Issuance Date
  
  MonthDayYear
- Country of Issuance
- Country of Birth
- Additional Information
- TSA Precheck or Global Entry Numbers
- Loyalty Member Numbers/Frequent Flyer Numbers
- Emergency Contact (If different than listed above)
  Name, Phone Number, Address, and Relation
- NOTE: Please write the name as it appears on your passport (for international travel) or other government issued identification.
- Name*
  
  PrefixFirst NameMiddle NameLast NameSuffix
- Date of Birth*
  
  MonthDayYear
  Date
- Gender*
  Required for airline and cruise line manifests to match travel identification.
- Phone Number (If different than listed above)
  Please enter a valid phone number.Format: (000) 000-0000.
- Email (If different than listed above)
  example@example.com
- Mailing Address (If different than listed above)
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Who are you rooming with? (If different than listed above)
  Please list all names that will share your room.
- Please provide your room category selection. Please refer to your quote for the correct room description. (If different than listed above)
  Example: Ocean View Suite-King Bed OR Garden View-2 Queen Beds OR Balcony Ocean View-King Bed
- Yes, traveler has a valid passportPassport expired, must renewDo not have a passportPassport not required for this trip
- Passport Number
  Passport information may be provided later if you haven't received yours yet.
- Passport Expiration Date
  
  MonthDayYear
- Passport Issuance Date
  
  MonthDayYear
- Country of Issuance
- Country of Birth
- Additional Information
- TSA Precheck or Global Entry Numbers
- Loyalty Member Numbers/Frequent Flyer Numbers
- Emergency Contact (If different than listed above)
  Name, Phone Number, Address, and Relation
- NOTE: Please write the name as it appears on your passport (for international travel) or other government issued identification.
- Name*
  
  PrefixFirst NameMiddle NameLast NameSuffix
- Date of Birth*
  
  MonthDayYear
  Date
- Gender*
  Required for airline and cruise line manifests to match travel identification.
- Phone Number (If different than listed above)
  Please enter a valid phone number.Format: (000) 000-0000.
- Email (If different than listed above)
  example@example.com
- Mailing Address (If different than listed above)
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Who are you rooming with? (If different than listed above)
  Please list all names that will share your room.
- Please provide your room category selection. Please refer to your quote for the correct room description. (If different than listed above)
- Yes, traveler has a valid passportPassport expired, must renewDo not have a passportPassport not required for this trip
- Passport Number
  Passport information may be provided later if you haven't received yours yet.
- Passport Expiration Date
  
  MonthDayYear
- Passport Issuance Date
  
  MonthDayYear
- Country of Issuance
- Country of Birth
- Additional Information
- TSA Precheck or Global Entry Numbers
- Loyalty Member Numbers/Frequent Flyer Numbers
- Emergency Contact (If different than listed above)
  Name, Phone Number, Address, and Relation
- NOTE: Please write the name as it appears on your passport (for international travel) or other government issued identification.
- Name*
  
  PrefixFirst NameMiddle NameLast NameSuffix
- Date of Birth*
  
  MonthDayYear
  Date
- Gender*
  Required for airline and cruise line manifests to match travel identification.
- Phone Number (If different than listed above)
  Please enter a valid phone number.Format: (000) 000-0000.
- Email (If different than listed above)
  example@example.com
- Mailing Address (If different than listed above)
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Who are you rooming with? (If different than listed above)
  Please list all names that will share your room.
- Please provide your room category selection. Please refer to your quote for the correct room description. (If different than listed above)
  Example: Ocean View Suite-King Bed OR Garden View-2 Queen Beds OR Balcony Ocean View-King Bed
- Yes, traveler has a valid passportPassport expired, must renewDo not have a passportPassport not required for this trip
- Passport Number
  Passport information may be provided later if you haven't received yours yet.
- Passport Expiration Date
  
  MonthDayYear
- Passport Issuance Date
  
  MonthDayYear
- Country of Issuance
- Country of Birth
- Additional Information
- TSA Precheck or Global Entry Numbers
- Loyalty Member Numbers/Frequent Flyer Numbers
- Emergency Contact (If different than listed above)
  Name, Phone Number, Address, and Relation
- NOTE: Please write the name as it appears on your passport (for international travel) or other government issued identification.
- Name*
  
  PrefixFirst NameMiddle NameLast NameSuffix
- Date of Birth*
  
  MonthDayYear
  Date
- Gender*
  Required for airline and cruise line manifests to match travel identification.
- Phone Number (If different than listed above)
  Please enter a valid phone number.Format: (000) 000-0000.
- Email (If different than listed above)
  example@example.com
- Mailing Address (If different than listed above)
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Who are you rooming with? (If different than listed above)
  Please list all names that will share your room.
- Please provide your room category selection. Please refer to your quote for the correct room description. (If different than listed above)
  Example: Ocean View Suite-King Bed OR Garden View-2 Queen Beds OR Balcony Ocean View-King Bed
- Yes, traveler has a valid passportPassport expired, must renewDo not have a passportPassport not required for this trip
- Passport Number
  Passport information may be provided later if you haven't received yours yet.
- Passport Expiration Date
  
  MonthDayYear
- Passport Issuance Date
  
  MonthDayYear
- Country of Issuance
- Country of Birth
- Additional Information
- TSA Precheck or Global Entry Numbers
- Loyalty Member Numbers/Frequent Flyer Numbers
- Emergency Contact (If different than listed above)
  Name, Phone Number, Address, and Relation
- NOTE: Please write the name as it appears on your passport (for international travel) or other government issued identification.
- Name*
  
  PrefixFirst NameMiddle NameLast NameSuffix
- Date of Birth*
  
  MonthDayYear
  Date
- Gender*
  Required for airline and cruise line manifests to match travel identification.
- Phone Number (If different than listed above)
  Please enter a valid phone number.Format: (000) 000-0000.
- Email (If different than listed above)
  example@example.com
- Mailing Address (If different than listed above)
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Who are you rooming with? (If different than listed above)
  Please list all names that will share your room.
- Please provide your room category selection. Please refer to your quote for the correct room description. (If different than listed above)
  Example: Ocean View Suite-King Bed OR Garden View-2 Queen Beds OR Balcony Ocean View-King Bed
- Yes, traveler has a valid passportPassport expired, must renewDo not have a passportPassport not required for this trip
- Passport Number
  Passport information may be provided later if you haven't received yours yet.
- Passport Expiration Date
  
  MonthDayYear
- Passport Issuance Date
  
  MonthDayYear
- Country of Issuance
- Country of Birth
- Additional Information
- TSA Precheck or Global Entry Numbers
- Loyalty Member Numbers/Frequent Flyer Numbers
- Emergency Contact (If different than listed above)
  Name, Phone Number, Address, and Relation
- NOTE: Please write the name as it appears on your passport (for international travel) or other government issued identification.
- Name*
  
  PrefixFirst NameMiddle NameLast NameSuffix
- Date of Birth*
  
  MonthDayYear
  Date
- Gender*
  Required for airline and cruise line manifests to match travel identification.
- Phone Number (If different than listed above)
  Please enter a valid phone number.Format: (000) 000-0000.
- Email (If different than listed above)
  example@example.com
- Mailing Address (If different than listed above)
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Who are you rooming with? (If different than listed above)
  Please list all names that will share your room.
- Please provide your room category selection. Please refer to your quote for the correct room description. (If different than listed above)
  Example: Ocean View Suite-King Bed OR Garden View-2 Queen Beds OR Balcony Ocean View-King Bed
- Yes, traveler has a valid passportPassport expired, must renewDo not have a passportPassport not required for this trip
- Passport Number
  Passport information may be provided later if you haven't received yours yet.
- Passport Expiration Date
  
  MonthDayYear
- Passport Issuance Date
  
  MonthDayYear
- Country of Issuance
- Country of Birth
- Additional Information
- TSA Precheck or Global Entry Numbers
- Loyalty Member Numbers/Frequent Flyer Numbers
- Emergency Contact (If different than listed above)
  Name, Phone Number, Address, and Relation
- NOTE: Please write the name as it appears on your passport (for international travel) or other government issued identification.
- Name*
  
  PrefixFirst NameMiddle NameLast NameSuffix
- Date of Birth*
  
  MonthDayYear
  Date
- Gender*
  Required for airline and cruise line manifests to match travel identification.
- Phone Number (If different than listed above)
  Please enter a valid phone number.Format: (000) 000-0000.
- Email (If different than listed above)
  example@example.com
- Mailing Address (If different than listed above)
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Who are you rooming with? (If different than listed above)
  Please list all names that will share your room.
- Please provide your room category selection. Please refer to your quote for the correct room description. (If different than listed above)
  Example: Ocean View Suite-King Bed OR Garden View-2 Queen Beds OR Balcony Ocean View-King Bed
- Yes, traveler has a valid passportPassport expired, must renewDo not have a passportPassport not required for this trip
- Passport Number
  Passport information may be provided later if you haven't received yours yet.
- Passport Expiration Date
  
  MonthDayYear
- Passport Issuance Date
  
  MonthDayYear
- Country of Issuance
- Country of Birth
- Additional Information
- TSA Precheck or Global Entry Numbers
- Loyalty Member Numbers/Frequent Flyer Numbers
- Emergency Contact (If different than listed above)
  Name, Phone Number, Address, and Relation
- Travel Insurance Advisory and Liability Disclaimer
- Hagan Hideaway Travel strongly recommends that all clients purchase comprehensive travel protection, including but not limited to trip cancellation, interruption, delay, medical, and travel accident coverage. This recommendation is made to safeguard your financial investment and ensure assistance in the event of unforeseen circumstances before or during travel.
  
  You acknowledge and understand that without travel insurance, you may be subject to significant financial loss. Cruise lines, airlines, hotels, and tour operators may impose strict cancellation penalties, including non-refundable deposits or full forfeiture of payments. All cancellation penalties, refund determinations, credits, and policy enforcement are governed solely by the individual travel suppliers, including but not limited to airlines, cruise lines, hotels, resorts, tour operators, and other travel providers. Hagan Hideaway Travel does not control these policies and cannot override supplier decisions regarding refunds, credits, schedule changes, or penalties.
  
  Additionally, most domestic health insurance policies do not provide medical coverage outside the United States. In many foreign destinations, hospitals and clinics may require upfront payment for services rendered. Travel protection policies often include a 24-hour assistance hotline to help facilitate care and coordination in such events.
  
  Please note that travel insurance coverage varies by provider and policy. Certain events—including, but not limited to, pandemics, epidemics, acts of war, natural disasters, severe weather, or government travel advisories—may be excluded from coverage. The information provided herein is for general informational purposes only and does not constitute a guarantee or binding assurance of coverage.
  
  Travel disruptions including but not limited to weather events, natural disasters, airline schedule changes, mechanical issues, strikes, government travel restrictions, border closures, acts of terrorism, civil unrest, illness, injury, missed connections, transportation interruptions, supplier bankruptcy, epidemics, pandemics, or other unforeseen events may impact travel plans. These events are beyond the control of Hagan Hideaway Travel and may result in delays, cancellations, or additional expenses. Hagan Hideaway Travel shall not be held responsible for losses, delays, injuries, damages, or additional costs resulting from such events.
  
  Force Majeure / Events Beyond Our Control
  
  Hagan Hideaway Travel shall not be liable for any failure or delay in the performance of travel arrangements due to circumstances beyond its control, including but not limited to acts of God, natural disasters, hurricanes, severe weather, fires, floods, earthquakes, epidemics, pandemics, public health emergencies, war, acts of terrorism, civil unrest, labor strikes, government actions, border closures, travel advisories, airline schedule changes, airport shutdowns, transportation interruptions, or supplier bankruptcy.
  
  In such events, travel suppliers may modify, postpone, substitute, or cancel travel services according to their own policies and terms and conditions. Hagan Hideaway Travel does not control supplier decisions regarding refunds, credits, rebooking, or compensation and cannot guarantee recovery of funds paid to travel suppliers.
  
  By declining travel insurance, or in the event of any claim denial by the insurer (including but not limited to claims related to COVID-19 or other policy exclusions), you agree to release, indemnify, and hold harmless Hagan Hideaway Travel, its agents, and affiliates from any and all liability, loss, cost, or damages arising from your decision.
  
  Your safety and satisfaction are of the highest importance to us. We appreciate your acknowledgment of this advisory and your understanding of the importance of travel protection in ensuring a secure and worry-free experience.
- Yes, protect my trip!No, I'll risk it!
- Trip Protection with future travel CREDIT ***If you cancel for any reason before departure, you’ll receive a 100% FUTURE TRAVEL CREDIT with the same travel supplier, typically valid for 12 months, varies by vendor; excluding the cost of this trip protection plan. No cash refund is issued. Ideal for travelers wanting flexibility at the lowest cost.Trip Protection with full REFUND ***Cancel for any reason before departure and receive a CASH REFUND to your original form of payment, excluding the cost of this trip protection plan. This option provides maximum flexibility and peace of mind but is typically more expensive than a travel credit.Traditional Travel Insurance ***Covers cancellation only for QUALIFYING OR COVERED reasons (such as certain illnesses, certain injuries, or severe weather depending on your purchased policy) and often includes medical coverage while traveling, emergency evacuation or transportation home, trip interruption, and baggage loss/delay protection. This is the most comprehensive and typically the most expensive option. Refunds for covered cancellations are issued to the original form of payment, minus the cost of the insurance policy itself.
- Travel Protection and Travel Purchase Acknowledgment
- By checking the box below, I hereby authorize the travel purchases listed above, including Trip Protection/Travel Insurance. I understand and acknowledge that the cost of the travel protection premium is non-refundable, regardless of whether the trip is canceled by me, a travel supplier, or any other party. I have reviewed and accept the terms and conditions of the policy provided by the insurance carrier and understand that all claims, coverage questions, and determinations are handled directly by the insurer in accordance with their policy provisions.*
  
  I am ACCEPTING Travel Insurance AND authorize the travel purchase.
- Please initial below using your finger, stylus, or mouse.*
- Travel Protection Waiver and Travel Purchase Acknowledgment
- By checking the box below, I acknowledge that travel protection has been offered to me and that I am voluntarily declining the purchase of travel insurance. I hereby authorize the travel purchases listed above and understand that by selecting this option I am declining the offer of Trip Protection/Travel Insurance. I confirm that I have been advised of the availability and benefits of such coverage, including protection against trip cancellation, interruption, delay, medical emergencies, and other unforeseen events.I understand that I have reviewed and accept all applicable cancellation policies, change penalties, and refund conditions associated with my travel arrangements. I further acknowledge that certain components of my trip—including but not limited to airline tickets, hotel stays, and other travel services—may be fully or partially non-refundable, subject to the terms and conditions of each travel supplier. I accept full financial responsibility for any losses, expenses, or penalties incurred as a result of cancellation, delay, missed travel, illness, injury, weather events, government travel restrictions, or other circumstances that may interrupt or prevent travel. I understand that without the purchase of travel protection, I may not be entitled to reimbursement for such losses. I also understand that in order to obtain the maximum benefits, including coverage for pre-existing medical conditions, travel protection must typically be purchased at the time of initial booking or prior to final payment, and must cover the full cost of all non-refundable trip components.By checking the box below, I release and hold harmless Hagan Hideaway Travel, its agents, and affiliates from any and all liability for losses incurred as a result of my decision to decline travel protection.*
  
  I am DECLINING Trip Protection/Travel Insurance BUT I do authorize the travel purchase.
- Please initial below using your finger, stylus, or mouse.*
- Yes, I will need international flights booked (outside of the United States)Yes, I will need domestic flights booked (within the United States)No, I won't be needing flights booked
- Airfare Courtesy and Trip Protection Notice:
  
  Please note, if airfare has been booked on your behalf, it has been arranged as a courtesy only and does NOT create any additional responsibility or liability for Hagan Hideaway Travel. Hagan Hideaway Travel is not the air carrier and does not control airline operations, policies, pricing, schedule changes, routing, equipment substitutions, seat assignments, baggage handling, class of service availability, cancellations, delays, denied boarding, or refund determinations. All airline tickets are subject to the individual terms and conditions of the issuing airline.
  
  Hagan Hideaway Travel is NOT responsible for, and shall not be liable for, flight schedule changes or cancellations, airline-imposed equipment or routing changes, delays, missed flights or connections, denied boarding, seat assignments, lost, delayed, or damaged baggage, refunds or credits issued by the airline, weather-related or mechanical disruptions, airport shutdowns, labor strikes, government actions, border closures, travel advisories, acts of terrorism, war, civil unrest, epidemics, pandemics, public health emergencies, natural disasters, or any other acts or events beyond its control.
  
  Any refunds, credits, rebooking options, or compensation are governed solely by the policies and decisions of the airline.
  
  Traveler is solely responsible for monitoring flight schedules directly with the airline prior to departure and for reviewing any schedule changes or notifications issued by the airline. Hagan Hideaway Travel is not responsible for missed flights, missed connections, cruise departures, tour departures, or other travel arrangements resulting from airline schedule changes or failure of the traveler to review airline communications.
  
  In the event of any airline-related issue, traveler agrees to resolve such matters directly with the airline and/or the travel insurance provider, if applicable.
  
  If airfare is booked as part of a vacation package, selected trip protection or travel insurance may include coverage for those flights, subject to policy terms and conditions. If airfare is booked separately, travel protection associated with a package will not extend to those flights. Separate flight protection may be purchased directly through the airline, from an independent insurance provider, or upon request through Hagan Hideaway Travel.
- Please initial below using your finger, stylus, or mouse.*
- If passport is required for international travel (outside of the United States), please attach a copy of your passport. Please upload passports for ALL passengers.
  
  Important Disclaimer: Airfare and other travel arrangements are booked as a courtesy service. All traveler information provided must match the legal name as it appears (or will appear) on the traveler’s passport. If the names entered on this form differ from the names listed on the official passport once issued, Hagan Hideaway Travel is not responsible for any fees, penalties, or rebooking costs that may result.
  Cancelof
- Passport/Visa Acknowledgment of Risk
  
  By initialing this section and completing this form, you acknowledge that it is your sole responsibility to obtain and hold a valid passport and any required visas prior to your scheduled departure date. Failure to secure the proper travel documents may result in denied boarding, cancellation penalties, or forfeited funds in accordance with the terms and conditions of the travel suppliers, InteleTravel, and Hagan Hideaway Travel.
  
  Please ensure that all traveler information entered matches exactly what appears (or will appear) on your passport. Hagan Hideaway Travel is not responsible for any errors, fees, or losses resulting from incorrect or incomplete passport or visa information, including discrepancies in names, dates of birth, or document details.
  
  By initialing this section and completing this form, you confirm that you have reviewed and understand all applicable cancellation and refund policies and accept full responsibility for obtaining valid travel documents prior to travel.
- Please initial below using your finger, stylus, or mouse.*
- If we are booking domestic flights (within the United States), please attach a copy of your government issued identification card. Please upload ID cards for ALL ADULT passengers.
  
  Important Disclaimer: Airfare and other travel arrangements are booked as a courtesy service. All traveler information provided must match the legal name as it appears (or will appear) on the traveler’s government issued identification card. If the names entered on this form differ from the names listed on the official government issued identification card once issued, Hagan Hideaway Travel is not responsible for any fees, penalties, or rebooking costs that may result.
  Cancelof
- Client Payment Authorization and Travel Services Agreement
  
  I understand that:
  
  • Final payment dates are determined by the travel supplier and may vary depending on the vendor and travel dates.
  • The remaining balance may be charged to the card provided on or shortly before the supplier’s final payment deadline unless an alternate form of payment is provided in advance.
  • I am responsible for ensuring the card on file remains valid and has sufficient available credit at the time of final payment.
  • If my card expires, is declined, or otherwise becomes invalid prior to final payment, I agree to provide updated payment information before the supplier’s deadline.
  • Failure to provide valid payment before the supplier’s final payment deadline may result in cancellation of the reservation and applicable supplier penalties.
  
  Merchant of Record Acknowledgement
  
  I understand that Hagan Hideaway Travel acts as an independent travel advisor and booking intermediary between the client and the travel suppliers providing travel services. Hagan Hideaway Travel does not provide the travel services directly.
  
  Travel services are provided by third party suppliers such as airlines, hotels, cruise lines, tour operators, transportation providers, and other travel vendors. In most cases, the travel supplier is the merchant of record and will process charges directly to my credit card.
  
  I acknowledge that Hagan Hideaway Travel does not control supplier pricing, availability, schedule changes, cancellations, or refund timelines. Refunds, credits, and penalties are governed solely by the supplier’s terms and conditions.
  
  Chargeback and Payment Dispute Agreement
  
  By authorizing payment, I agree that the transaction is valid and authorized by the cardholder. I agree that I will not initiate a chargeback or payment dispute for authorized travel charges and understand that any billing concerns must first be addressed directly with the travel supplier or Hagan Hideaway Travel.
  
  I understand that travel purchases may include non-refundable deposits, cancellation penalties, or supplier imposed fees depending on the timing of cancellation and the supplier’s policies.
  
  I agree that any concerns regarding cancellations, service issues, refunds, or changes must first be addressed with the travel supplier according to their terms and conditions.
  
  If a chargeback or payment dispute is initiated for an authorized charge, I acknowledge that this signed authorization may be provided as evidence that the purchase was approved by the cardholder.
  
  Client Acknowledgement
  
  By initialling this authorization, I confirm that:
  
  • I have reviewed and approved the travel services requested.
  • I authorize payment using the card provided.
  • I understand and accept the supplier terms and conditions governing this reservation.
- Please initial below using your finger, stylus, or mouse.*
- YesNo
- I authorize the card listed above to be used for all authorized travel charges related to this reservation, including deposits and final payment when due.
- I do NOT authorize the card listed above to be used for automatic final payment. This card may only be used for the specific charge authorized at this time. If a balance remains on my reservation, I understand that a new payment authorization form and valid credit card must be submitted prior to the travel supplier’s final payment deadline. Failure to provide updated payment authorization before the final payment due date may result in cancellation of the reservation and applicable supplier penalties.
- Please initial below using your finger, stylus, or mouse.*
- Cardholder Authorization
  
  By providing the credit or debit card information on this form, I certify that I am the authorized cardholder and that I authorize payment for the travel services requested. I understand that the charges listed are for travel arrangements that I have personally requested and approved.
  
  I authorize the travel supplier and/or InteleTravel.com to charge my card for the amount agreed upon for the travel services associated with this reservation.
  
  I agree to pay for this purchase in accordance with the issuing bank cardholder agreement.
  
  I confirm that the traveler names, travel dates, destination, and reservation details associated with this booking have been reviewed and approved by me and are accurate.
  
  I acknowledge that this authorization constitutes my electronic signature and approval of the travel services requested.
- Please sign your full signature below using your finger, stylus, or mouse.*
  
  Powered by Jotform SignClear
- Printed Name*
  
  First NameMiddle NameLast Name
- Today's Date*
  
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- Hagan Hideaway Travel
  
  Daniell Hagan, Independent Travel Agent, ID#P431124 HaganHideawayTravel@gmail.com +1 (719) 761-7266 HaganHideawayTravel.com
- Travel Purchase Authorization For Non-Website Purchases.
  
  Thank you for your travel purchase.
  
  Hagan Hideaway Travel/InteleTravel.com is pleased to confirm the following travel arrangements. To complete your transaction and confirm your arrangements, your signature on this authorization is required. This form is NOT required for electronic purchases that you complete yourself on our website, daniellhagan.inteletravel.com, www.InteleTravel.com, or its affiliates. Charges are payable ONLY to InteleTravel.com or directly to the hotel, resort, tour operator, cruise line or other travel supplier. Independent Travel Advisors cannot accept and process charges through any other account, nor can we accept checks, cash or other forms of payment.
  
  Disclosure:
  
  All rates subject to restrictions, availability and change. See www.InteleTravel.com for complete terms and conditions. InteleTravel.com is registered with the States of Florida (ST-32452), Washington (602-735-106), California (209-1941-40), Iowa (977), and Hawaii (TAR 6732) as a seller of travel. InteleTravel.com uses the personal data you disclose about yourself on this form only for the purpose of processing your requested travel purchase. We retain your personally identifiable data only as long as that processing requires. We do not share any of your personal data with any third party except for the purpose of completing your purchase, and then only with third-party travel providers and credit card processors who protect and only process your personal data for the limited purpose of this travel purchase. Following the completion of your travel that is the subject of this transaction, your personal information shall be securely destroyed unless InteleTravel.com is required by law to retain it, and then it will be retained only for that limited legally required purpose. For complete details regarding the protection of your personal information, please see InteleTravel.com’s Privacy Policy posted at www.inteletravel.com. © InteleTravel.com 2025
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Travel Protection Waiver and Travel Purchase Acknowledgment

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