Make a Payment
This form authorizes Her Travel Experience, LLC to charge your credit or debit card for the trip described. Please contact us with any questions at hertravelexperience@gmail.com or 318-655-2336.
Please indicate for which trip this form is being submitted. *
Please provide Names (as listed on passport) and Date-of-Birth for all guests.
Guest Names & Date of Birth *
Today's total payment $ *
Credit/Debit Card Type *
Credit/Debit Card Number *
Name on Card *
Expiration Date *
3 Digit Security Code (4 Digits AMEX) *
Billing Address *
City *
State *
Zip Code *
Telephone Number *
Email address *
It is strongly recommended to purchase Travel Insurance. If you choose not to purchase insurance, you understand you are liable for any change or cancellation penalties and out-of-pocket expenses incurred. You will also make your own provisions in the event of an emergency while traveling.
Travel Insurance? *
Authorization? *
Required
Customer Electronic Signature *
Date *
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