Secure Payment Form

In order for K. Hector Consulting to accept and bill your credit card, please complete all fields below, sign, date and click submit.

All information sent is strictly confidential and K. Hector Consulting adheres to the highest standards of account data protection.

Please fill out all boxes with an * in order for it to submit correctly!! The top box corresponds with the word underneath.

STOP!!! If your passport expires within 6 months of travel date, please go fill out renewal paperwork now!!!

Full Name and Destination (List Host Name if part of a Group)

Example: Kim/Jamaica

Picture of Passport *

Click or drag files to this area to upload. You can upload up to 4 files.

If No Passport, Fill Out Section Below:

Only Fill Out Traveler #1 & #2 if Passport is Being Renewed. Otherwise, please upload clear photo.

Traveler #1 (Name As Seen on Passport)

First

Middle

Last

Please enter your name as it appears on your Passport

Traveler #1: Date of Birth

Example: 06/21/1981

Traveler #1 Loyalty Rewards (Name and Number)

Example: Skymiles 259454XXXX

Traveler #2 (Name As Seen on Passport)

First

Middle

Last

Please enter your name as it appears on your Passport

Traveler #2: Date of Birth

Example: 06/21/1981

Traveler #2 Loyalty Rewards (Name and Number)

Example: Skymiles 259454XXXX

Departure Airport *

Example: ATL, MIA

Is payment including fees for ALL parties? *

Room Type and Preferred Airline

Billing Information

Please enter Billing Information as it appears on your Credit Card Statement.

Note: Credit Card information cannot be changed once payment is processed.

SUBMISSION OF THIS FORM WILL NOT PROCESS A CHARGE!

Full Name (as it appears on your credit card) *

First

Middle

Last

Phone *

Email *

Confirm Email

Note: must match current email on file

Billing Address *

Address Line 1

Address Line 2

City

State

Zip Code

Must be the address where your credit card is shipped.

Type of Credit Card *

Credit Card Number *

Expiration Date *

Example: 12/2024

CVV *

Security Code

One Time Payment Amount *

USD

Acceptance *

I hereby authorize K. Hector Consulting to charge the indicated credit card the amount indicated above. This is a one-time charge authorization. I am not authorizing K. Hector Consulting to setup my account within a recurring billing system. I understand that if I want K. Hector Consulting to charge any balances to my credit card in the future, I will need to submit another authorization form at that time or choose the selection below.

Signature *

Please type out your Full Name AS Signature

Date / Time *

Date

Time