Credit Card Payment Authorization

The Creole Poet Credit Card Payment Authorization - COMPLETE THIS FORM ONLY IF using YOUR current CR CARD INFO ON FILE WITH THE CREOLE POET, previously provided VIA THE ESIGNGENIE/FOXIT SECURE DOC LINK. If using a NEW cr card, a secure link will be emailed to you to use to provide the NEW cr card info
Select One*
Requested payment process date. Payment will be processed as close to your requested date as possible.*

MonthDayYear
INSTRUCTIONS: Please complete, sign, and click the submit button for this online form to provide authorization for processing your payment IF YOUR CR CARD INFO IS ON FILE WITH THE CREOLE POET VIA THE ESIGNGENIE/FOXIT SECURE DOC LINK, phone, text, or other.

IF YOUR CR CARD INFO IS NOT ON FILE, once this form is submitted, a eSignGenie/FOXIT secure link online document will be emailed to you to use to provide your cr card info for porcessing your payment.

NOTE: This form provides your authorization ONLY. Your payment will be processed by the travel agent into the travel supplers booking system once you provide your cr card authorization via this form AND your cr card info via the eSignGenie secure doc. Please DO NOT enter credit card number on this form.
Name on the Card*

First NameMiddle NameLast Name
Phone Number*

Area CodePhone Number
Billing Address (the address that the cr card company sends the bill to you)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Your Email:*
Cruise/Vacation Payment Amount*

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USDCruise/Vacation Payment
This Payment is for NOTE: Please complete a separate form for the deposit and to set up an interim or a payment plan (CHECK ONE box in this section):*

DEPOSIT: Cruise/Vacation Deposit (non refundable) WITHOUT Vacation Protection (check one or the other in the deposit section not both)DEPOSIT: Cruise/Vacation Deposit (non refundable) WITH Vacation Protection (non refundable) INCLUDED. If checked ADD the vac protection amount on your booking to the deposit payment (check one or the other in the deposit section not both) if not included in the quoteINTERIM Payment Plan AFTER DEPOSIT payment for an interim payment only: Check here if applying an interim payment to a pending Cruise/VacationPayment plan AFTER DEPOSIT: Check here to begin a payment plan. Indicate in the payment notes below the amount to process and payment start month/date. NOTE: Bookings made 40-60 days prior to travel ARE NOT eligible for a payment planFINAL/FULL PAYMENT: Cruise/Vacation Apply Final Balance/Full PaymentOTHER - Enter details below in the Payment Notes section
Payment Instructions (CHECK ONE box in this section)*

DEPOSIT PAYMENT: Process the deposit payment to the cr card previously provided via Esigngenie/Foxit. If there is no cr card info currently on file with The Creole Poet, or if using a NEW cr card once this form is completed and submitted, a secure eSignGenie link to the online document will be emailed to you to use to provide your NEW cr card infoINTERIM/PAYMENT PLAN: Process the interim/payment plan to to the SAME cr card previously provided for the deposit on the secure eSignGenie/Foxit online documentINTERIM/PAYMENT PLAN: Process the interim/payment plan to to a DIFFERENT cr card than previously provided for the deposit on the secure eSignGenie/Foxit online document. Once this form is completed and submitted, a secure eSignGenie/Foxit link will be emailed to you to use to provide your NEW cr card info via secure online document.FINAL PAYMENT: Option 1: Process the final payment to the SAME cr card previously provided on the secure eSignGenie/Foxit online documentFINAL PAYMENT: Option 2: Process the final payment plan to to a DIFFERENT cr card than previously provided on the secure eSignGenie/Foxit online document Once this form is completed and submitted, a secure eSignGenie/Foxit link to the online document will be emailed to you to use to provide your NEW cr card info via secure document.
Payment Plans: enter payment plan start date. Payment will be processed as close to your requested date as possible.

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Payment Notes: PLEASE DO NOT ENTER CR CARD NUMBER ON THIS FORM

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Vacation Protection - non refundable (For most travel suppliers, everyone on the booking must purchase to have it) CHECK ONE box in this section*

Vacation Protection DECLINED - Check this box if YOU ARE NOT purchasing vacation protection (check one box in this section)CRUISE ONLY - Vacation Protection PURCHASE AFTER DEPOSIT - check this box if YOU ARE purchasing vacation protection AFTER DEPOSIT prior to or with the final payment (check one box in this section)VACATION PROTECTION INCLUDED on the existing booking (check one box in this section)
Card Info
I will be paying using:*
PLEASE NOTE: This form ONLY provides your signature to authorize payment. Your cr card information must be provided via an EsignGenie/Foxit secure document for your payment to be MANUALLY processed to your booking.

As an IATAN accredited travel agent, I am registered with the Cruise Lines and Travel Suppliers to book your vacation and process payments directly into their system.

I have provided this secure online cr card auth form to obtain signature to authorize payment. NOTE: Travel suppliers require I have a signature to process payments.

I will email a secure EsignGenie document link to a separate secure form for you to use to provide your credit card information IF YOU DO NOT HAVE YOUR CR CARD INFO ON FILE.

Debit Cards: Please check with your bank to ensure that your daily limit will allow the amount to be charged to go through. Sometimes the bank will put a hold on the amount charged that will drop off in a few days.

Payment Plans will be processed as requested on the form submitted on or as close to the requested date as possible. Note: The last payment may be a partial amount based on the remaining amount due. A payment confirmation will be sent to you each time a payment is processed.
Authorization/ Acknowledgement
Authorization:*

By submitting this form, I do hereby authorize The Creole Poet to charge the above card in the amount indicated and for all payments on this booking. The Creole Poet assumes no responsibility for changes made to a reservation if the payment fails to process. I am also acknowledging that I am the cardholder held under penalty of law and that I have read and agree with the terms and conditions including cancellation penalty.
Signature - use cursor to sign your name here*

Clear
Today's Date*

MonthDayYear
Booking Information -
Booking Number if assigned. If not yet assigned show TBA in this box
Travel Supplier - for example, Carnival Cruise Line, Royal Caribbean, Funjet Vacations, United Vacations, American Airlines Vacations, etc.
Travel Dates
Traveling with a group? Please enter the name of the group that you are traveling with here
Full Name as listed on travel document: Passport (if required), driver's license and birth certificate if applicable (married ladies last as on Driver's License) If initial sign up for a cruise/vacation please list additional full names and DOB incl yr per booking in the notes box below

First NameMiddle NameLast Name
Destination - for example Mexico, Jamaica, Bahamas, etc.
Date of birth incl year
NOTES: If initial sign up for a cruise/vacation please provide first middle last name as listed on travel document and date of birth including the year for each person listed on the booking

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If you are unable to send this form online, please print the blank form, complete, and sign. Take a cell phone photo and text to
713-560-3284 or email to thecreolepoet@gmail.com over a secure encrypted connection or fax to 281-436-0406 (Direct Fax).

The Creole Poet is an IATAN accredited travel agency. Denise Prejean IATAN Accredited Travel Agent. Ofc 281.436.0405 Cell 713.560.3284 Email thecreolepoet@gmail.com Website www.thecreolepoet.com
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Card Info

Authorization/ Acknowledgement

Booking Information -