Please sign and complete this form to authorize The Curated Travel Collection to make a debit to your credit card listed below.

By signing this form, you give us permission to debit your account for the amount indicated on or after the indicated date. This is permission for a single transaction only and does not provide authorization for any additional unrelated debits or credits to your account, unless specified below, or in a written authorization for future transactions.

Please complete all fields. You may cancel this authorization at any time by contacting us. This authorization will remain in effect until cancelled.

Client Information

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

Complete the following for each person in your travel party:
Full name - including middle names (as shown on travel documentation) *

Complete the following for each person in your travel party:
Birthdays of each traveler ( you can copy names from above and add birthdays) *

Shipping Address (if different from Billing Address)

Planning Packages - Curated Destinations

Please choose the non refundable planning package that best fits your travel needs. If choosing the Bronze Package -- you can input "0" in the amount to be charged. All other amounts listed below would be charged to your credit card in a separate transaction. *

Bronze Package (complimentary)

Silver Package ($250.00)

Gold Package ($325.00)

Payment Information

Name on Card *

Credit Card Type *

Credit Card Number *

Expiration Date (mm/yy) *

CVV Code *

Date of payment * +

Amount to be Charged (Vacation Deposit) *

Amount to be Charged (Planning Package) *

Description of Services *

Name of my agent *

Credit Card Authorization *

I authorize the above-named agent with The Curated Travel Collection to charge the credit card indicated in this authorization form according to the terms outlined above. This payment authorization is for the goods/services described above, for the amount indicated above only, and is valid for one time use only. I certify that I am an authorized user of this credit card and that I will not dispute the payment with my credit card company; so long as the transaction corresponds to the terms indicated in this form.

Future Transactions *

I understand that my credit card information will be saved to file for future transactions on my account.

Terms and Conditions *

I have read and agree to The Curated Travel Collection LLC's Terms and Conditions.

Signature *

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