TravelJoy

Cassondra Alston

Dekay Travel

03 Make A Payment

May 1, 2023 to Jan 7, 2030

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h1" label="Dekay Travel Credit Card/ Authorization Form"/>&#13;
		<field type="paragraph" subtype="p" label="Thank you for choosing Dekay Travel. Please use this form to submit a payment towards your trip. Once your payment has been processed you will get a comfirmation and updated balance."/>&#13;
		<field type="paragraph" subtype="p" label="This form serves as our Credit Card Authorization Form. By signing this document you authorize Dekay Travel and our travel suppliers to debit your Credit/Debit card in the amount agreed upon, on or after the indicated date. Your signature is required to process the payments for your travel package."/>&#13;
		<field type="text" required="true" label="Booking Number" placeholder="Booking Number" name="booking-number" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Lead Traveler Name"/>&#13;
		<field type="text" required="true" label="First name" name="first-name" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Last name" name="last-name" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Email" name="email" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Phone number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="date" required="true" label="Payment Processing Date" description="Please select the date you would like payment to be processed." name="payment-processing-date" className="form-control"/>&#13;
		<field type="text" required="true" label="Please specify the amount you'd like processed and applied to your travel package" placeholder="$100." name="please-specify-the-amount-youd-like-processed-and-applied-to-your-travel-package" subtype="text" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>

By signing below, I authorize Dekay Travel to charge the credit card provided herein.

Click to sign