Billing Information

Full Name as it appears on Credit Card: *
Billing Address: *
City: *
State/Province: *
Zip/Postal Code: *

Credit Card Information:

Select Your Card Type: *
Card Number:*
Expiration Date: *
Code: *
Amount to be charged on Credit Card: $ *
Check if you authorize us to make payment on this credit card for the amount stated. *
Check if you authorize us to automatically make final payment on this credit card on the due date. Traveler Information:
Confirmation/Booking Number: *
Group/Wedding Name (if applicable):
First Name: *
Last Name: *
Departure Date: *
Return Date: *
What is the name of the VIP agent you are working with?
Contact Email Address: *
Contact Phone Number: *
Additional Comments:

Terms and Conditions:

In providing our clients with thorough service, VIP is associated with one or more travel affiliates. By clicking submit, you certify that you are the card holder and that you authorize VIP Vacations, Inc. or their affiliates to charge your credit card in the amount indicated. You are further advised that the posted charge may be in the name of VIP Vacations, Inc. or one of its affiliates. You may request from VIP Vacations, Inc. the name of the affiliate that will appear on your statement.

Penalties may apply for changes and/or cancellations. Please check and initial below to accept these Terms & Conditions and process your payment.

Accept VIP Vacations Terms & Conditions: *
Please Initial here: *