Fax (704) 543-6089
E Mail: donna@thehoneymoonplanner.net



I, (print name)______________________________ acknowledge charges made to my credit card for related charges described hereon and am aware of applicable restrictions and/or penalties as shown on such ticket(s) and/or coupons. I hereby authorize The Honeymoon Planner to charge travel expenses to the card below at my request.

X______________________________________________
Signature of Cardholder

Todays Date ____________________

________________________________________________________________
Address
________________________________________________________________
City State, Zip

____________________________________________ VI MC DS AX
Credit Card Number exp. date

$________________________
Amount

___________________________________________
E Mail Address

______________
# of Travelers

___________
# of Nights

___________
Air Desired

___________
Gateway City

Insurance is always strongly recommended.

Circle one:
Y - Insurance Desired-Yes I desire Travel Insuranceƒnƒn

N - Insurance Waived-No, I choose to decline Travel Insurance