<form-template>
	<fields>
		<field type="header" subtype="h2" label="Lead Traveler's Name"/>
		<field type="text" required="true" label="Legal First Name (as it appears on Government ID / Passport)" name="first-name" subtype="text" className="form-control"/>
		<field type="text" label="Preferred First Name (if any)" name="preferred-name" subtype="text" className="form-control"/>
		<field type="text" required="true" label="Last name" name="last-name" subtype="text" className="form-control"/>
		<field type="text" required="true" label="Email" name="email" subtype="text" className="form-control"/>
		<field type="text" required="true" label="Mobile Phone Number" name="phone-number" subtype="text" className="form-control"/>
		<field type="text" required="true" label="Travel Departure Date" name="travel-departure-date" subtype="text" className="form-control"/>
		<field type="text" required="true" label="Destination, Group Name, Proposal or Invoice Number&amp;nbsp;" name="destination-group-name-proposal-or-invoice-number-" subtype="text" className="form-control"/>
		<field type="text" label="Enter the amount to authorize (deposit or entire trip amount with this method of payment):" description="In the event that you would like to change your credit/debit card on future installment payments  you are able to do so." name="amount" subtype="text" className="form-control"/>
	</fields>
</form-template>

Enter the amount you would like to authorize:

Please add or choose card to authorize:

Sign and agree to the terms and conditions:

Terms & Conditions

I authorize both The DS3 Group/LUXE Worldwide Travel to charge the credit card or bank account indicated on this invoice for the noted amount on today's date. This payment is for the services described on the invoice. Statement charges shall appear on my credit card as LUXE WORLDWIDE TRAVEL / DS3 or any of LUXE's designated Suppliers.

I understand that returns, refunds, and cancellations are at the discretion of The DS3 Group/LUXE Worldwide Travel. I certify that I am an authorized user of this credit card and that I will not dispute the payment with my credit card company, so long as the transaction corresponds to the terms indicated on this invoice.

Unless specified Trip Deposits are non-refundable and non-transferable. Any future payments may be subject to the terms and conditions of the Travel Insurance Policy, LUXE Travel can assist you with filing a claim, if need be, in order to have any portions refunded in case of cancellation due to covered reasons as specified in your Travel Insurance. If you decline Travel Insurance, your payments are non-refundable, once paid to the Supplier, Airline, Operator, Cruise Line or Hotel as applicable.

As Cardholder I authorize The DS3 Group/LUXE Worldwide Travel to keep my signature and credit card on file for future travel purchases. I acknowledge that I am responsible for any penalties to be paid for changes and/or cancellations occurring after the ticket purchase.

I understand that prices are subject to availability, as Quotes on Travel Reservations are not binding until they are booked with the Supplier, Hotel, Cruise, Rental Car Company, Tour Operator or Airline.

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