Share your information with Mark Carpenter

Mark Carpenter

Seas, Summits, & Skies Travel, LLC

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	<fields><field type="text" subtype="text" required="true" label="First name" className="form-control" name="first-name"></field><field type="text" subtype="text" required="true" label="Last name" className="form-control" name="last-name"></field><field type="text" subtype="text" required="true" label="Email" className="form-control" name="email"></field>&#13;
		<field type="header" subtype="h2" label="Credit Card Information"/>&#13;
		<field type="date" label="Today&#39;s date" name="date-1772997882729" className="form-control"/>&#13;
		<field type="paragraph" subtype="p" label="I authorize Seas, Summits, and Skies Travel operating as an affiliate of Cornerstone Collective and/or the travel supplier to charge my credits cards for the agreed upon amount stated in the accepted proposal for travel arrangements."/>&#13;
		<field type="radio-group" required="true" label="Your Response" inline="true" name="your-response">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="paragraph" subtype="p" label="TRAVEL PURCHASE AUTHORIZATION For Non-Website Purchases. Thank you for your purchase, I am pleased to confirm your travel arrangements. To complete your transaction and confirm your arrangements, your signature on this authorization is required. Charges are payable ONLY to the hotel, resort, tour operator, cruise line, other travel supplier, and/or independent Travel Advisor for specified booking fees (if applicable)."/>&#13;
		<field type="radio-group" label="Do you agree?" name="do-you-agree">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
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		<field type="text" required="true" label="Type your Initials" name="type-your-initials" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h3" label="Travel Insurance&amp;nbsp;"/>&#13;
		<field type="paragraph" subtype="p" label="TRAVEL INSURANCE WAIVER For your protection, Travel Insurance is strongly recommended and available upon request. You can enroll for travel protection for Medical Expenses, Baggage Delays/Losses, trip Delay or Cancellation, and other coverage, or I can arrange coverage for you based on your needs."/>&#13;
		<field type="text" label="I have ACCEPTED and authorized the travel purchases above, including travel insurance, and I am aware the insurance premium is not refundable. (Type your initials)" name="i-have-accepted-and-authorized-the-travel-purchases-above-including-travel-insurance-and-i-am-aware-the-insurance-premium-is-not-refundable-type-your-initials" subtype="text" className="form-control"/>&#13;
		<field type="paragraph" subtype="p" label="TO DECLINE RECOMMENDED TRAVEL INSURANCE YOUR acknowledgement of THIS INSURANCE WAIVER IS REQUIRED. Final Travel Documents (tickets, vouchers, etc.) cannot be sent to you before receipt of the signed insurance waiver."/>&#13;
		<field type="text" label="I have ACCEPTED and authorized the travel purchases above, and I understand that by signing below, I am DECLINING TRAVEL INSURANCE. I have read and understand all cancellation charges and change fees related to the above travel arrangements, and that I may not be entitled to a full refund should my travel plans change. In case of cancellation of nonrefundable airline tickets or other arrangements, I agree to pay all applicable penalties according to the travel supplier&#39;s rules.(Type your initials)" name="i-have-accepted-and-authorized-the-travel-purchases-above-and-i-understand-that-by-signing-below-i-am-declining-travel-insurance-i-have-read-and-understand-all-cancellation-charges-and-change-fees-related-to-the-above-travel-arrangements-and-that-i-may-not-be-entitled-to-a-full-refund-should-my-travel-plans-change-in-case-of-cancellation-of-nonrefundable-airline-tickets-or-other-arrangements-i-agree-to-pay-all-applicable-penalties-according-to-the-travel-suppliers-rulestype-your-initials" subtype="text" className="form-control"/>&#13;
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1

Enter the amount you would like to authorize:

1

Enter the amount you would like to authorize:

2

Please add or choose card to authorize:

2

Please add or choose card to authorize:

3

Sign and agree to the terms and conditions:

3

Sign and agree to the terms and conditions:

By signing below, I authorize Seas, Summits, & Skies Travel, LLC to charge the credit card provided herein.

Click to sign