Payer Information
Todays Date :
REQUIRED - Your Name :(Exactly as it appears on your Credit Card)
Your
Billing Address :(Address and Zip must match CC billing
address)
Cell Phone
Evening/Other Phone
Best Number to Text You
REQUIRED - Email Address
Best Way to
Reach You :
Travel Counselor Name
Passenger Information
Passenger #1 :
Name: as it appears on
Passport:
Birthdate:
Passport #:
Passport Exp. Date:
Passenger #2 :
Name as it appears on
Passport:
Birthdate :
Passport #:
Passport Exp.
Date:
EMERGENCY CONTACT INFORMATION
EMERGENCY Contact Name
EMERGENCY Contact Relationship
EMERGENCY Contact Phone
EMERGENCY Contact EMail
Trip Details
Destination Resort or
Cruise:
Room or Cabin
Category:
Destination Country:
Departure Date
January
February
March
April
May
June
July
August
September
October
November
December
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
2023
2024
2025
2026
Provide Exact
Dates
Return Date
January
February
March
April
May
June
July
August
September
October
November
December
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
2023
2024
2025
2026
Provide Exact
Dates
Credit Card Details
Total Trip Cost:
I Approve This Payment
Amount: Balance will be charged automatically on due date unless
otherwise advised.
This Payment is
For:
Total Balance Due
Partial Payment
Deposit
Other - Specify at Right
Type of Card
REQUIRED - Credit Card Number
-
REQUIRED
REQUIRED - Expiration Date:
01 - January
02 - February
03 - March
04 - April
05 - May
06 - June
07 - July
08 - August
09 - September
10 - October
11 - November
12 - December
- Provide exact
date
REQUIRED - Security Code # :
-
REQUIRED
Amex - 4 digit number above CC# on FRONT of
card
MC, V, DIS - last 3 digit number on BACK signature
strip
Additional Information or Requests: For example:
location in resort, cruise deck, birthday's, anniversaries, etc...
Must
Check the following to complete reservation
You MUST select ONE of the 3 options below.
I have ACCEPTED TRIP INSURANCE - Classic Plan
I have ACCEPTED TRIP INSURANCE - Classic Plan with Required to work
I have DECLINED TRIP INSURANCE - By checking this box, I acknowledge that I have been offered and I have declined the purchase of: Trip cancellation (including airline, cruise, and tour operator default) and travel accident/limited sickness/medical/trip interruptions insurance. I will not hold CASTAWAYS TRAVEL, Fox Ascoli Travel, Inc, d/b/a Fox Travel and/or its owners, agents, contractors or employees responsible for any expense or loss incurred by me resulting from delay/cancellation of my trip, accident sickness, death, infection, stolen or damaged baggage or lost property. Optional Travel Protection Coverage offered by ALLIANZ TRAVEL INSURANCE is available only to residents of the United States.
- - - -
HEDONISM OPTION: Add this alone or in addition to a plan above. Hedonism permits change/re booking within one year. Hedonism does not refund room cost nor other travel expenses.
HEDONISM only: I have ACCEPTED Hedonism Change for Any Reason coverage for $55/person, subject to change by resort .
SEND
then WAIT FOR THE CONFIRMATION. If you see the confirmation page, that
means that we have received your payment information. If you get any
type of ERROR message or did not get redirected to a confirmation
page ... that means that we did not receive your payment information
Please contact us via e-mail at info@castawaystravel.com or by phone
at 281-363-0808.