Trip Information

Today's Date * +

Group Name (if you are not traveling with a "Group", please select other) *

Booking Number (if applicable)

Travel Dates * +

Number of Adult Travelers *

Number of Travelers under 17 years old

Number of Rooms

Preferred Room Choice

Room Occupancy

Secondary Room Choice

Message to Agent:

Primary Traveler

FIRST Name: *

MIDDLE Name:

LAST Name: *

Mailing Address: *

Apt, Unit, Suite:

City: *

State: *

Zip Code: *

Birth Date: * +

Phone #: *

Email: *

Special Requests/Needs

Medical

Dietary

Other

Please Specify

Would you like to add Airfare to your Package? *

Preferred Airport:

Known Traveler Number/Global Entry Number:

Guest Information #2 (if applicable)

FIRST Name:

MIDDLE Name:

LAST Name:

Mailing Address:

Apt, Unit, Suite:

City:

State:

Zip Code:

Birth Date: +

Phone #:

Email:

Special Requests/Needs

Medical

Dietary

Other

Please Specify

Would you like to add Airfare to your Package?

Preferred Airport:

Guest Information #3 (if applicable)

FIRST Name:

MIDDLE Name:

LAST Name:

Mailing Address:

Apt, Unit, Suite:

City:

State:

Zip Code:

Birth Date: +

Phone #:

Email:

Special Requests/Needs

Medical

Dietary

Other

Please Specify

Would you like to add Airfare to your Package?

Preferred Airport:

Guest Information #4 (if applicable)

FIRST Name:

MIDDLE Name:

LAST Name:

Mailing Address:

Apt, Unit, Suite:

City:

State:

Zip Code:

Birth Date: +

Phone #:

Email:

Special Requests/Needs

Medical

Dietary

Other

Please Specify

Would you like to add Airfare to your Package?

Preferred Airport:

Guest Information #5 (if applicable)

FIRST Name:

MIDDLE Name:

LAST Name:

Mailing Address:

Apt, Unit, Suite:

City:

State:

Zip Code:

Birth Date: +

Phone #:

Email:

Special Requests/Needs

Medical

Dietary

Other

Please Specify

Would you like to add Airfare to your Package?

Preferred Airport:

Passports

A United States Passport, issued by the United States Department of State, is required for all U.S. citizens and nationals traveling outside the United States. iButterFly Travel Experience strongly recommends all of our clients travel with a valid passport. However, U.S. citizens embarking on a cruise that both originates and terminates at the same U.S. port are not required to have a passport but will need proof of citizenship such as an original or certified copy of a birth certificate, a certificate of naturalization, a passport card, an enhanced driver’s license as well as a government-issued photo ID. Children are also required to bring proof of citizenship. Children 16 and older, are also required to bring a photo ID. *

I have a valid US issued Passport.

My Passport has expired or will expire within 6 months after returning from my trip. To renew your passport: https://travel.state.gov/content/travel/en/passports.html

I do not have a Passport. To obtain a Passport: https://travel.state.gov/content/travel/en/passports.html

A Passport is not required for this trip. (traveling within the Continental USA)

Travel Protection

We believe that you upcoming trip is a significant investment. For this reason, we strongly recommend you purchase Travel Protection. If you choose to decline this valuable coverage, you are assuming any financial loss associated with your travel arrangements. Would you like to purchase Travel Protection? *

YES, I choose to purchase Travel Protection. Please send a quote.

NO, I have been offered Travel Protection and I choose to decline. I understand that I am assuming full responsibility for all fees, cancellation fees and/or penalties.

Travel Disruption

By checking this box, you are acknowledging you requested iButterFly Travel Experience, to make one or more travel bookings on your behalf. As the worldwide COVID-19 coronavirus pandemic remains ongoing at this time, I acknowledge that for this reason, and other reasons not reasonably foreseeable at this time, these travel plans may be interrupted or cancelled by the supplier that is providing them, a government entity or other third party over which Agency has no control. I further acknowledge that the supplier’s own cancellation, rebooking and refund policies, subject to any applicable law that is now or may later be in effect, will govern my rights and remedies, including my right to receive a refund, in such an event. Moreover, I understand that should I elect to purchase travel insurance, the terms of the policy will dictate whether, and to what extent, coverage for any financial loss may exist under the circumstances. By signing below, I hereby agree to hold this travel agency harmless and release it from any and all liability for any damages, including but not limited to monetary losses, I may incur as a result of such interruption or cancellation of these travel plans. *

I acknowledge the Travel Disruption Policy

Credit Card ChargeBack Policy

All fraud including credit card fraud will not be accepted by the iButterFly Travel Experience, LLC., and as such will be fully investigated and pursued under the law to its fullest extent. Any losses resulting on the behalf of iButterFly Travel Experience, LLC., will be fully pursued in a civil lawsuit to claim back any losses incurred covering all business, legal fees, research costs, human resource and loss of income. *

I acknowledge the Credit Card Fraud/Chargeback Policy

Payment Information

Invoicing *

Single invoice to Primary Traveler

Separate Invoices for Each Guest | Room Total Split Evenly (each traveler needs to complete an individual form)

Booking Number: (if applicable)

Payment Type

Payment Amount (initial deposit is non-refundable)

Name (as it appears on card)

Credit Card Number

Credit Card CVV Security Code

Expiration Date

Billing Address:

City

State

Zip Code

For security purposes, you may recieve a seperate email requesting the Task Verification of your Personal Contact & Travel Information, Passport Information (if you have one), Credit Card Information and Insurance Waiver Acknowledgement if you decline Travel Protection.

Payment Plan: Automatic Monthly payments will be process on the 15th-18th of the month and charged to the credit card listed above. You will receive a monthly invoice/receipt. *

Divided My Balance into Equally Monthly Payments

Pay In Full

Pay Balance on or before Final Payment Date

Uplift Financing: if approved, there is no money down and you may have up to 24 months to payoff your vacation. Schedule your consultation today https://www.schedulicity.com/scheduling/ITET6Y

Grace period: At times we may be traveling or out of the country and unavailable to process your payment on the 15th. If this should occur, your payment will be process upon our return, not to exceed 7 business days.

Holidays/Weekends: If the 15th should fall on a Holiday or Weekend, your payment will be process the next official work day.

Credit Card Authorization

As the primary traveler on this reservation and on behalf of all guests on reservation: I understand this is a disclosure of business practices and permissive credit/debit card payment agreement for the purchase of travel services. I agree that payments may be made directly to selected travel suppliers on my behalf by iButterFly Travel Experience, LLC.; paid in prorated amounts not to exceed the sum total of approved charges. I understand Debit Cards often impose "Daily Charge Limits" and multiple payments may be needed to complete the full balance due; for which you will be notified if the situation occurs. iButterFly Travel Experience, LLC., will not release personal information to ANY parties not listed above, unless provided in writing as an Emergency Contact and will apply due diligence in maintaining records in a secure, safe location. Authorization is required to charge your credit card or debit card. Your completion of this authorization form helps us to protect you, our valued clients form credit card fraud. All information on this form is kept strictly confidential. Your Electronic Signature provides iButterFly Travel Experience, LLC., an affiliate of KHM Travel Group, the authorization to process the payment as you have requested.

YES: As named Cardholder, I authorize iButterFly Travel Experience (agent Kenya Davis-Paramore) to charge my credit card for the above amount. This process can take up to 48 hours.

YES: I understand that iButterFly Travel Experience (agent Kenya Davis-Paramore) will automatically charge the Credit Card on file as indicated in the Payment Plan.

YES: I understand that iButterFly Travel Experience (agent Kenya Davis-Paramore) will automatically charge any remaining balances to my credit card on the Final Balance Due Date.

YES: I understand that it is my responsibility to notify iButterFly Travel of any changes to my Credit Card on file (i.e. fraud, expiration, closed account). Failure to do so will result in a $10 reprocessing fee per declined transaction.

Please Sign Here: *

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