WP E-Signature by Approve Me - Sign Documents Using WordPress -

Reservation Payment

Please verify your information, then sign below.

PRIMARY TRAVELER INFORMATION:

Passenger 1:

ADDITIONAL TRAVELERS (if applicable):

Passenger 2:

Passenger 3:

Passenger 4:

Passenger 5:

Passenger 6:

Passenger 7:

Passenger 8:

Passenger 9:

PAYMENT INFORMATION:

Name of Cardholder:

Credit Card To Charge: CVV: Expiration Date:

Amount To Charge:

Billing Address: ,

Please charge my credit card referenced above in the amount of . I understand and accept all of the terms and conditions regarding this booking, including cancellation policies and applicable penalties, and agree not to dispute nor chargeback any of the above charges. I agree that payments may be made direct to selected travel suppliers on my behalf by Shoreside Travel, paid in prorated amounts not to exceed the sum total of approved charges. I acknowledge that I have been offered Travel Insurance to protect my vacation.

If you are using a debit card with a daily spending limit, it is your responsibility to contact your bank to give them permission to authorize the transaction. If they require the name of the vendor and you are unsure as to who that is, please contact us so we may assist you.

Leave this empty:

Your legal name

Your email address

Please Confirm full name and signature.

Draw Signature
Type In Signature

Draw your signature with your mouse, tablet or smartphone Clear

I agree that I am and I agree this is a legal representation of my signature for all purposes just the same as a pen-and-paper signature

I agree that I am and I understand this is a legal representation of my signature

Adopt & Sign

Timestamp

Audit

2017-04-27 17:57:08 CDT

Reservation Payment Uploaded by David Glenn - confirmations@shoresidetravel.com IP 104.190.245.211