Credit Card Payment Information
Please answer all questions. Enter "NA" if question does not apply to you.
VAC# (Returning Clients of EMTravels) *
Example: VAC1000
Your answer
Event Name *
Example: Super Bowl, Virgo Trip, Singles Trip, etc
Your answer
Travel Date: *
Example: 9/21/2012 - 9/25/2012
Your answer
Who referred/invited you? *
Example: Jane Doe
Your answer
Passenger's Full Name *
Example: John Doe
Your answer
Date of Birth *
Instructions: Click the down arrow to find your month. Scroll up using the slider to find your birth year
MM
/
DD
/
YYYY
Amount to be Charged: *
Example: 245.34
Your answer
Credit Card or Debit Card *
Card Number: *
Your answer
Credit Card Expiration - Month *
Credit Card Expiration - Year *
Credit Card Security Code: *
( VISA, MC or Discover - 3 digit code on back of card. ) ( AMEX - 4 digit code on front of card. )
Your answer
Cardholder's Name: *
Your answer
Credit Card Billing Address: *
Your answer
City: *
Your answer
State: *
Your answer
Zip Code: *
Your answer
Contact Info: Phone number *
Example: 404-123-1234
Your answer
Email Address *
Your answer
Name of roommate(s) *
Your answer
Desired room category *
Required
Special Request: *
Required
Check for discounts? *
Required
Please enter your cruise line past guest number *
Your answer
Who is this payment for? *
If payment is for roommate(s), provide roommate's D.O.B and email address *
Your answer
Any additional information. Dietary restrictions, desired room/cabin location, etc. *
Your answer
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