Payments - Wishing Well Travel

Agent

Name on reservation *

Confirmation #

Payment Options *

Payment

Full Amount

Amount of Payment *

Please tell us how much you would like to pay

Name as it appears on Credit Card

Credit Card

Credit Card Number

Expiration Date

CVV Code

Billing Address *

Is your mailing address the same as your billing address? *

Yes

No

Mailing Address if different from billing

Phone Number *

Additional Information -

Terms & Conditions

Affiliation and Responsibility 

Wishing Well Travel is not affiliated with the Walt Disney Company.  Wishing Well Travel issues travel documents in the sole capacity as agent for the supplier as indicated in travel documents, brochures, quotes or other communication. As the agent of the supplier, Wishing Well Travel  does not assume the responsibility for the cancellation or substitution of service by the supplier, financial default of the supplier, refunds or unused services to be provided by the supplier, or any obligation, service or monies not the specific responsibility of Wishing Well Travel . 

Authorization  

The person submitting this form, being at least eighteen years of age and a legal resident of the United States or Canada, is hereby authorizing Wishing Well Travel to purchase a Disney Vacation and/or other associated travel components with the Credit Card provided. 

Wishing Well Travel must make deposits, progress payments and final payments using its client's credit card(s). Authorization for such payments is granted upon client's submission of his/her payment information to Wishing Well Travel via this web-based submission form. Wishing Well Travel will retain credit card information for future payments in a secure location until time of travel is complete.  Wishing Well Travel  will not apply payments for the client without the client's express permission, granted herein. Wishing Well Travel shall not be held responsible for cancellation of travel by the supplier if resulting from late final payment. 

Accuracy of Information  

The person submitting this form hereby attests, under penalty of law, that he/she is the rightful owner of the Credit Card or Gift Card being used.  Furthermore, the person submitting this form also attests that the billing name and address provided are correctly associated with the payment method used. 

Vacation Protection Insurance  

By submitting this payment, and therefore accepting the Vacation Quote and these Terms and Conditions, the client agrees that he/she was provided the option to purchase Vacation Proection Insurance (except residents of the state of Washington), and made the decision, on their own, to Accept or Decline such insurance. 

Destination Terms and Conditions  

By submitting this payment, and therefore accepting the Vacation Quote and these Terms and Conditions, the client also acknowledges and agrees to the specific Terms and Conditions established by the respective vacation destination, including cancellation policies.   

Acceptance  

By checking the box below, and by clicking the "Submit" button, you are authorizing Wishing Well Travel to reserve the specified vacation on your behalf, using the method of payment provided above. Furthermore, you agree that you have read and understand all of Wishing Well Travel's, Disney's, and/or Universal Orlando's Terms and Conditions, and that you understand the cancellation policies and penalties that apply to your vacation.

Agree to Terms *

I agree to the Terms & Conditions above

Electronic Signature *