Simply World Class
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    SIMPLY WORLD CLASS & PERFECT REFLECTIONS TRAVEL
    REGISTRATION & DEBIT/CREDIT CARD AUTHORIZATION FORM

    By submitting this form, you authorize Simply World Class and/or Perfect Reflections Travel, to debit/charge your card for travel services and you agree to the terms and conditions of the Supplier(s) who will be providing your travel services. ​Your signature is required to complete your travel plans. Please read the cancellation/change penalties that may apply to changes or cancellations of your travel.

    A completed registration and debit/credit card authorization form is required for Simply World Class and/or Perfect Reflections Travel to process your flexible monthly payments (if applicable). You will be required to complete an updated registration and debit/credit card authorization if your debit or credit card details change. This will help to avoid confusion and relieve any issues just in case you may need to switch cards, inform us of any changes to your trip account (additions/removals of roommates, changes to travel dates, etc., or your advanced/monthly payment/ final balance amount differs from the previous month(s). Please submit to avoid late fees and/or penalties. Thank you.

    Any questions or concerns, please contact Simply World Class or Perfect Reflections Travel.
    ​
    NOTE: Fields below marked with *​ are required.

    INDEPENDENT TRAVEL AGENT:  Kim A. Woodruff / Simply World Class
    TELEPHONE NUMBER:  (617) 293-0793
    FAX NUMBER:  N/A
    EMAIL ADDRESS:  SWC@simplyworldclass.com

    ​CUSTOMER INFORMATION

    FULL NAME EXAMPLES

    John Harry Smith
    Jane Marie Johnson

    OR

    John H Smith
    Jane M Johnson

    If no middle name, just list First & Last Name only.

    TRAVEL PURCHASE AUTHORIZATION

    For Non-Website Purchases. Thank you for your purchase.
    ​Simply World Class and/or Perfect Reflections Travel are pleased to confirm the following travel arrangements.  To complete your transaction and confirm your arrangements, your signature on this authorization is required.  This form is NOT required for electronic purchases you complete yourself on our website(s), www.SimplyWorldClass.com or www.GOPRT.com. or its affiliates. Charges are payable ONLY to Simply World Class and/or Perfect Reflections Travel or the hotel, resort, tour operator, cruise line or other travel supplier. Simply World Class and/or Perfect Reflections Travel may not accept and process charges through any other account, or accept checks, cash or other forms of payment.

    TRAVEL INSURANCE WAIVER

    For your protection, Travel Insurance is strongly recommended and available upon request from Simply World Class and/or Perfect Reflections Travel. You can choose to ACCEPT travel protection for Medical Expenses, Baggage Delays/Loss, Trip Delay or Cancellation, and other coverage, and ​Simply World Class and/or Perfect Reflections Travel can arrange coverage for you through our provider, Allianz Travel Insurance.

    PLEASE NOTE:  
    Travel insurance coverage is an add-on option which must be paid at time of initial deposit.
    Cost is based per person, by age, the state you reside in, and the total cost of your travel package which is eligible for travel protection.

    To DECLINE recommended travel insurance, your signature on this insurance waiver form is required. Final Travel Documents (tickets, vouchers, etc.) cannot be sent to your prior to receipt of the signed insurance waiver.
    I, the debit/credit card holder, authorize Simply World Class & Perfect Reflections Travel to debit/charge my debit/credit card account for my travel services. By checking this box and submitting this form, I agree to the terms and conditions of the Supplier who will be providing my travel services. Click button if you agree.

    TRAVEL ARRANGEMENTS

    Enter your FULL NAME (first/middle/last) DATE OF BIRTH, and AGE you will be at time of travel.

    EXAMPLE:
    John Brian Smith | 10/05/1965 | 56

    OR if middle name is not spelled out as exactly shown on passport...

    John B Smith | 10/05/1965 | 56
    LEAVE BLANK if you are not sharing a room.

    If you are sharing a room, ONLY list the FULL names of those who will be rooming with you.

    Provide their FULL NAME (first/middle/last) DATE OF BIRTH, and AGE they will be at time of travel.

    EXAMPLE:
    Janice Marie Smith | 01/01/1972 | 50

    OR if middle name is not spelled out as exactly shown on passport...

    Janice M. Smith | 01/01/1972 | 50

    If no middle name, only list first & last name only with date of birth, and age at time of travel.

    Janice Smith | 01/01/1972 | 50

    If you are sharing a room, ONLY list the addresses of those who will be rooming with you if the passenger's address is different from yours.

    EXAMPLE:
    Janice Marie Smith | 01/01/1972 | 50
    Janice M. Smith | 01/01/1972 | 50
    Janice Smith | 01/01/1972 | 50
    555 Anywhere St
    Anyplace, MO 55555

    TRAVEL INSURANCE

    Travel Insurance: Please indicate if you wish to YES (Accept) the travel insurance offered for your cabin package or you choose NO (Decline) to not take the insurance. Please note you WILL NOT be allowed to ADD it later once the booking is completed. You will be required to obtain travel insurance outside of Simply World Class and Perfect Reflections Travel.

    For travelers who ACCEPT, this will be an add-on option and you must pay the travel insurance cost upfront for your travel package during the initial booking.

    (Example: If the cost for insurance for you is $78, then you must pay the $200 initial deposit + $78 insurance = $278 for deposit.)

    ​PAYMENT INFORMATION & AUTHORIZATION

    Please list full names of ALL who are registering under this booking and for who you are paying for.

    Please verify all legal names and list each passenger's full name on a separate line and AS EXACTLY SHOWN ON THE GOVERNMENT-ISSUED ID OR PASSPORT.

    Example:
    - Jane Marie Smith or Jane M. Smith or Jane Smith
    - George Lee Smith or George L. Smith or George Smith

    PAYMENT PLANS & METHODS

    Payment Plan: Please indicate YES or NO if you are looking to be on a flexible payment plan.

    Your monthly payments will be based on your initial deposit and final balance due date.

    Please note, late payments may cause automatic cancellations or late fees. Final balances are due by the due date -- NO EXCEPTIONS!
    Please note $$$ amount you are authorizing for initial deposit per adult person AND monthly payment per person

    EXAMPLE:
    (A) $200 initial deposit/per adult person (excluding travel insurance), and a monthly per person payment based on the balance with final balance due date.

    (B) $500 initial deposit (excluding travel insurance) and a monthly per person payment based on the balance with final balance due 03/01/2023.

    (C) Full payment (indicated $$$ of total package amount)

    TRAVELER INFORMATION

    Please complete this form as accurate as possible. If a question does not apply to you, please leave blank.
    Choose One. All Major Credit and Debit Cards Accepted. NO Holds, NO Exceptions.
    Please provide full and correct debit or credit number. DO NOT INCLUDE DASHES OR HYPHENS ( - )
    2-digit mm/yy (i.e. 01/23 or 10/22)
    The CVV code is either the three digits on the back of your card for Visa, MasterCard and Discover or the four digits on the front of your American Express card that you'll find after your account number.

    Visa/MC/Discover: 3-Digit Code
    American Express: 4-Digit Code
    Put First Name and Middle Name or Initial in the first box as it appears on your card. Please put a space (i.e. Jane Marie OR Jane M) and Last Name ONLY in second box.
    Middle name or initial, if applicable, and appears on your card.
    Complete with address that is associated with the debit or credit card you are authorizing and using to make payment.

    For STATE you can note PROVINCE here if your country is not USA.

    (If your Mailing Address is Different, please provide in the "Amount Authorized/Payment Plan/Comment" section below.)
    Complete with phone number that is best to reach you for questions regarding your travel trip (home or work)
    Email addresses are case sensitive. Please be sure to indicate your email accurately to avoid delays in processing deposits/payments or forwarding e-documents for travel.

    EXAMPLE:
    janesmith413@yahoo.com
    johnbsmith@yahoo.com
    Rjohnson@msn.com
    SWC@simplyworldclass.com
    SPECIAL REQUESTS & COMMENTS:
    Indicate here any special requests, instructions, dietary restrictions, etc. we need to be aware.

    Please note there are certain requests we cannot guarantee (i.e. room assignments, location of room/floor level other than what has been paid for, near elevators or a friend, etc.)

    EXAMPLES:
    - Dietary restrictions (vegan, vegetarian, gluten-free, etc.)
    - Special accessibility, handicap-accessible room required, etc.
    - Please NO ground level room
    - Please hypo-allergenic/feather-free room
    - Please assign me a room close to or near Jane Marie Smith.
    - Please assign me a room close to the pool or beach.
    Please electronically sign with full name for submission.

    EXAMPLE:
    Jane M Smith OR
    Jane Marie Smith
    Please electronically sign with today's date for submission. (MM/DD/YYYY)
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