guns and hoses cruise card authorization form 4 by b6owQ81Z

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									CARDHOLDER AUTHORIZATION FORM
Date:_____________________________
Agent Name:_Brian Gamble___Agent ID:____________
I,_______________________________________________________
authorize Guns and Hoses Travel to charge the amount of $_(see chart below)
for the following services: Guns and Hoses Cruise and lodging
to my: (circle one) Visa/ MasterCard /American Express/ Diners/ Discover
Card # _____________________________________________________
Exp. Date: _______________ (Please note, we can not accept cards that expire
before 9/2010) CCV/CID# _____________
_______________________________________________________
(exact name as it appears on credit card)
VISA, MASTERCARD, DINERS & DISCOVER credit cards have a three-digit (CVV)
number. It is printed in the signature panel on the back of the Visa, MasterCard and
Discover cards. The verification number is the last 3 digits on the right side of the panel.
AMERICAN EXPRESS credit cards have a 4 digit non-embossed number. It is printed above the
account number on the front of your card. It may appear to the left or to the right, but it is always
above your account number.
DEBIT CARDS or if your card has no verification code, enter 0000 in the CVV/CID field.
Billing Address: This must be the address where your statement is mailed.
Street___________________________________________________

City: __________________________ State_______ Zip: __________

Cardholder’s Signature: _________________________
Date: ___________
I/we are aware of any cancellation policies and agree not to dispute or attempt to
chargeback any of the above signed for and acknowledged charges.
_____________
(cardholder initial)


CREDIT CARD AUTHORIZED TRANSACTIONS
NAME:________________________________________________
TRIP SUMMARY (Destination): Guns and Hoses Cruise 2010
Number of passengers traveling: _____
Special Notes: ______________________________________
Cost/Charges:_______________________________________
NOTE: THERE ARE NO REFUNDS/CANCELLATIONS ON CABINS OR BUS SEATS AFTER
MAY 1, 2010! If you do not cancel or request a refund before this date, you will still be
responsible for the full fare of your cruise and all deposits/payments will be forfeited! You
may cancel up to May 1, 2010 with out penalty (unless you requested a “Best Fare” cabin.
“Best Fare” cabins are non-cancelleable and non-refundable).

□ Inside Cabin (SOLO TRAVELER)
Initial Deposit $60 DUE upon booking
 nd
2 Installment - $100 charged on January 1, 2010
 rd
3 Installment - $100 charged on March 1, 2010
Final Installment - $102.50 or balance charged on May 1, 2010

□ Inside Cabin (DOUBLE OCCUPANCY)
Initial Deposit $85 DUE upon booking
 nd
2 Installment - $125 charged on January 1, 2010
 rd
3 Installment - $125 charged on March 1, 2010
 th
4 Installment - $150 charged on May 1, 2010
Final Installment - $205 or balance charged on July 1, 2010

□ Inside Cabin (TRIPLE OCCUPANCY)
Initial Deposit $150 DUE upon booking
 nd
2 Installment - $250 charged on January 1, 2010
 rd
3 Installment - $250 charged on March 1, 2010
Final Installment - $297.50 or balance charged on May 1, 2010

□ Inside Cabin (QUAD OCCUPANCY)
Initial Deposit $200 DUE upon booking
 nd
2 Installment - $250 charged on January 1, 2010
 rd
3 Installment - $200 charged on March 1, 2010
 th
4 Installment - $200 charged on May 1, 2010
Final Installment - $226.40 or balance charged on July 1, 2010

□ Ocean View Cabin (SOLO TRAVELER)
Initial Deposit $70 DUE upon booking
 nd
2 Installment - $100 charged on January 1, 2010
 rd
3 Installment - $100 charged on March 1, 2010
Final Installment - $152.50 or balance charged on May 1, 2010

□ Ocean View Cabin (DOUBLE OCCUPANCY)
Initial Deposit $90 DUE upon booking
 nd
2 Installment - $150 charged on January 1, 2010
 rd
3 Installment - $150 charged on March 1, 2010
 th
4 Installment - $150 charged on May 1, 2010
Final Installment - $255 or balance charged on July 1, 2010

□ Balcony Cabin (DOUBLE OCCUPANCY)
Initial Deposit $95 DUE upon booking
 nd
2 Installment - $150 charged on December 1, 2009
 rd
3 Installment - $150 charged on February 1, 2010
 th
4 Installment - $150 charged on March 1, 2010
 th
5 Installment - $150 charged on May 1, 2010
Final Installment - $200 or balance charged on July 1, 2010
□ Jr. Suite (DOUBLE OCCUPANCY)
Initial Deposit $500 DUE upon booking
 nd
2 Installment - $250 charged on December 1, 2009
 rd
3 Installment - $250 charged on February 1, 2010
 th
4 Installment - $250 charged on March 1, 2010
Final Installment - $285 or balance charged on May 1, 2010
(Note: Suite prices are subject to change daily. Price will be quoted at time of booking)

Notice: Any payments that are not able to be processed due to decline or invalid card
numbers are subject to a $25 penalty per week the payment goes over due, and the
cabin/bus seat becomes subject to cancellation without refund.

□ Bill me for the Party Bus $150 per couple*

□ Bill me for the Party Bus $85 for Solo Traveler *

□ Bill me for the VIP Package (Includes VIP bus for 2, hotel in South Beach for 2, and
more) $300 per couple *

□ Bill me for Travel Insurance. I will receive the price when I get my quote. I understand
when selecting travel insurance, I may be able to get a partial/full refund after the deadline
if I select the CANCEL FOR ANY REASON option. (see below waiver/sign up form)

□ Bill me for the VIP Package (Includes VIP bus for 2, hotel in South Beach for 2, and
more) $300 per couple *

□ Bill me for the Private Group Charter Excursion (TBA) Excursions are non-refundable. If
you missed the excursion, you are not eligible for a refund. Only a missed port qualifies for an
excursion refund.

       Payments made may read Guns and Hoses Productions, GNH Prod or Carnival
        Cruise Lines on your credit card statement.
       Bus seats are refundable up to May 1, 2010. No refunds after May 1, 2010.

Create your own payment plan: (Must be approved by Guns and Hoses Travel)

Initial deposit:_________________________ Date:____________
Add’l amt paid:________________________ Date:____________
Add’l amt paid:________________________ Date:____________
Add’l amt paid:________________________ Date:___________
Final pymt:___________________________ Date: Must be paid by 7/1/10
Comments:___________________________________________________

                  Be sure to check the box of the proper payment/cabin type.
    Once your form is completed, please fax to (352) 504-0137 or (888) 984-6737 or email to
                              service@gunsandhosestravel.com

 If you are going to pay by check, please send checks post dated for these amounts and dates.
           You will be notified 72 hours before the checks are deposited as a reminder.
                                    Mail checks to/made out to:
                  Guns and Hoses Travel - 8028 Gibson Terrace, Leesburg, FL 34748


     NOTE: Your cabin will NOT be booked until this completed form has been received.
 PLEASE NOTE: There are NO REFUNDS AFTER MAY 1, 2010. IF YOU CANCEL AFTER THIS DATE,
  YOU WILL LOOSE YOUR PAYMENTS MADE. UP TO MAY 1, YOU CAN CANCEL WITH OUT ANY
        PENALTY AT ALL, and will receive a full refund, if requested before May 1, 2010 .

                                                       Legal Disclaimer
Guns and Hoses Cruise and all its subsidiaries, affiliates, operators and members can not be held liable for any actions or
happenings on, after, or during the cruise. By signing up with Guns and Hoses Cruise, you waive all liabilty of Guns and
Hoses, the operator, and all members affiliated with as such. Your booking means you agree to hold Guns and Hoses
Travel, Brian Gamble and affiliates harmless for any actions or any of your actions before, during and after the cruise.

By signing up, you also accept that all images, still and video, taken on, before, or after the cruse, become property of
Guns and Hoses Travel and the operator. These pictures can be used for any purpose to promote future Guns and Hoses
Cruises or other travel, memorabilia, and whatever the operator deems useful. You waive any and all claims to any
images, any royalties or proceeds that may come from their use. You understand the ship is considered a "public area"
and consent to pictures being taken and may be used for commercial, promotional, or any other purposes. By booking,
you claim that you are a reasonable, responsible legal adult, and will only consume alcohol if you are of the legal age in
the state of Florida.


                    IMPORTANT TRAVEL INSURANCE INFORMATION

INSURANCE WAIVER
IMPORTANT INFORMATION REGARDING TRAVEL INSURANCE
Client’s Name ___________________________________________
Date of Departure ________________________________________
PLEASE READ THIS CAREFULLY
Now that you have arranged your trip, as professional travel agents we feel that it is our
responsibility to recommend travel insurance to protect your investment. Please read the
attached Travel Insurance brochure carefully in order to make an informed decision concerning
this important matter. Ask us or call us with any questions you may have.
AT THE TIME OF FIRST PAYMENT:
�� I have been advised of the cancellation penalties for my purchase. I acknowledge receipt of the
Travel Insurance brochure.
�� I understand that Travel Insurance can protect me from possible loss of money due to supplier
bankruptcy/default, unexpected trip cancellation/interruption due to accident, sickness or death,
baggage loss, medical expenses, and emergency air transportation costs.
�� I understand that I must purchase Travel Insurance immediately to obtain maximum coverage.
AT THIS TIME, I CHOOSE: (CHECK ONE)
To purchase the recommended insurance, I have mailed my completed Travel Insurance
application to Guns and Hoses Travel.

�� I accept the recommended insurance and will pay within 24 hours.
�� To decline the recommended insurance.
�� To think about my decision.
Name (Please Print) ______________________________________________
Signature ____________________________________ Date ___________
Return this form to your Travel Agent
                      GUNS AND HOSES TRAVEL/KHM TRAVEL GROUP
                   TRAVEL VACATION INSURANCE AUTHORIZED VENDOR

								
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