Credit Card Authorization Form Twitter Date * Form completed by: First Name * Last Name * I authorize Downunder Travel Ltd and/or their appointed suppliers to charge my credit card the total amount show here. Being payment for my/our travel arrangements made by Downunder Travel Ltd. For your security, please call your Consultant with your credit card number. * Visa MasterCard American Express Lead passenger name: First Name * Last Name * Billing Address: Street Address * Address Line 2 City * Postal / Zip Code * State / Province / Region * - Select Province/State - Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon ==================== Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Select Country * Afghanistan Åland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia, Plurinational State of Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, the Democratic Republic of the Cook Islands Costa Rica Côte d'Ivoire Croatia Cuba Curaçao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran, Islamic Republic of Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea, Democratic People's Republic of Korea, Republic of Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia, the former Yugoslav Republic of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States of Moldova, Republic of Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory, Occupied Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Réunion Romania Russian Federation Rwanda Saint Barthélemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syrian Arab Republic Taiwan, Province of China Tajikistan Tanzania, United Republic of Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela, Bolivarian Republic of Viet Nam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Please mail my travel documents to a different address Yes No Phone Number * Email * Seat Preference * Window Middle Aisle Dietary Restrictions * Yes No Travel Consultant's Name * Would you like to sign up for the latest news and promotions from Downunder Travel? Downunder Travel respects your privacy and in doing so will not divulge your contact information to any third parties. Yes, please No, thank you TRAVEL INSURANCE WAIVER Please complete below to indicate if you wish to purchase the insurance that was recommended to you. I have been advised by Downunder Travel agent that the following travel insurance discussed is available and understand that by opting out of insuranceany expenses incurred, while not covered by a travel insurance policy, will be of my own financial responsibility. My travel agent/agency has no responsibility for these possible expenses. Emergency excess hospital and medical insurance? * Yes No Trip Cancellation and Interruption Insurance? * Yes No Please provide any additional information if needed: How Did You Hear About Us? * Online Advertisement Google Search Referred by friend TV Radio Print Other I agree to the Downunder Travel terms and conditions found on this website. To view terms and conditions click on the link below. I agree to the Downunder Travel terms and conditions found on this website. To view terms and conditions click on the link below. View Terms and Conditions All bookings are subject to availability at time of booking. Prices advertised are in Canadian dollars. Prices are subject to change without notice until such time as the package is booked and paid for. Downunder Travel Ltd. is the agent/broker in this equation and for that reason is not responsible for any issues or incidents which result in clients expenditure outside of the package booked paid for and agreed upon. All passengers traveling to Australia onwards must have an Australian Travel Visa. Please advise your Downunder Travel Specialist should you be traveling on anything other than a Canadian or U.S. passport. Airfare, taxes & fuel surcharges component of package must be paid in full at time of booking at which time the airfare becomes non-refundable. Downunder Travel highly recommends that all passengers protect themselves with cancellation / interruption insurance which will cover them against cancellations due to non pre-existing medical conditions which cause them penalties or other expenses. We also highly recommend medical insurance for any travel outside of your home province. Your Downunder Travel Specialist can assist with both Cancellation/Interruption Insurance and Medical Insurance. Security question: What is twelve minus 2? *