Online Secure Payment Form

This form allows you to provide Barefoot Travel Travel & Wine with payment information for an EXISTING reservation. Use of this form is 100% optional as we are always happy to talk with you and collect this information by phone or in person.

Note: Submitting your information does not imply that your payment has been processed. Please look for a confirmation of your payment from our office within one full business day.

My Vacation Specialist: * 🛈

My Travel Order # (leave blank if unknown): 🛈

Your Departure Date: * +

LEAD PASSENGER INFORMATION

First Name: * 🛈

Last Name: * 🛈

Primary Phone: *

Phone Type *

Credit Card BILLING STREET ADDRESS: *

Credit Card BILLING CITY *

Credit Card BILLING STATE *

BILLING ZIP CODE *

Email of Card Holder *

Notes to Your Agent - Please use this space to detail any notes your agent may need about this payment like if you're paying for multiple cabins, extra items, etc.

Payment Type: *

Credit Card