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Secure Credit Card Payment Form

Note: Your card will not be charged when you submit this form. If you have questions please contact travel@videretravel.com or call +1.720.453.3562

Phone Number:
Passenger Name/s AS APPEARS ON PASSPORT and Date of Birth for all passengers:
Description of charge
Travel Dates
 

BILLING INFO

Credit card

Name As on Card

Billing Address - Street

Billing Address - City

Billing Address - State

Billing Address - Zip

Card number
Expiration date

Customer Identification Number (3 or 4 digit code)

I authorize Videre Travel, Coastline Travel and any suppliers involved in my travel itinerary to charge my credit card account as specified by email for deposit and final payment for all services. By purchasing any of the products or services included in the itinerary, I agree to be bound by the individual supplier's terms and cancellation policies, and understand a detailed copy of supplier policies can be requested at any time.


Thank You!