Contracted Group

FIRST NAME:*

LAST NAME:*

TYPE OF RESERVATION:*

Wedding Group

Family Reunion

Birthday Celebration

Milestone Celebration

Other

I AUTHORIZE A PAYMENT IN THE AMOUNT OF ______. (USD$)*

I AGREE TO PAY THE ENTIRE BALANCE OF THE CONTRACTED GROUP AND CHARGEBACKS, IF APPLICABLE.*

Yes, I agree.

I GUARANTEE AND WARRANT I AM THE LEGAL CARDHOLDER FOR THE FOLLOWING CREDIT CARD.*

Yes, I am the legal cardholder.

FIRST NAME:*

LAST NAME:*

CARDHOLDER'S FIRST NAME*

CARDHOLDER'S LAST NAME*

CARDHOLDER'S PHONE NUMBER:*

CARDHOLDER'S EMAIL ADDRESS:*

CARD TYPE:*

VISA

Master Card

Amex

Discover

CREDIT CARD NUMBER:*

MONTH:*

YEAR:*

SECURITY CODE:*

CARDHOLDER'S BILLING ADDRESS:*

Street Address Address Line 2 City State ZIP Code

READ BEFORE YOU SIGN

By signing your name below and selecting the submit button, you are authorizing this financial transaction electronically. This enters you into a financial agreement with YJJ Travel Corp. and one of their travel supplier affiliates. You agree your electronic signature is the legal equivalent of your manual signature on this transaction. You consent to be legally bound by this transaction and all financial terms and conditions of this agreement. You agree to not dispute this charge to YJJ Travel Corp. or one of their travel supplier affiliates after the payment has been successfully processed. If you'd like to confirm the name of a travel supplier once a payment posted you will contact YJJ Travel Corp. If you agree, kindly sign below.

PLEASE SIGN BELOW:*

TODAY'S DATE:*

SIGNER'S FIRST NAME:

SIGNER'S LAST NAME:

Email

This field is for validation purposes and should be left unchanged.

Thank You for Securing Your Group Travel Accommodations with YJJ Travel Corp.!

Kindly Complete The Following Credit Card Authorization To Successfully Apply Payment Towards Your Group Contract.

READ BEFORE YOU SIGN

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