JCo Client Information Form

JCo Client Information Form

Jco all other form Form Preview
  • Agent Name:                Janelle Grissinger

  • Client Information Form

  • Contact Information:

  •  -
  •  -

  • Passenger Names: (Please List Full Legal Names of All Passengers)

  • Full names must be listed as they appear on your government issued identification and passport for all travelers. If additional space is needed use the space located at the bottom of the form.

  • Please include the information of the person completing the form, if that person is traveling.

  • Travel Insurance:

  • Passports/Visas:

  • Air Carriers and Baggage:

  • Change/Cancellation:

  • Credit Card Information: Form is sent via a secure connection and only accessible by Janelle & Co. Travel LLC. To remain PCI complaint we can only collect the last 4 digits to be stored. Please email the 1st 12 digits and the CV code from the back of card to janelle@janellecotravel.com . This will be kept separate from the last 4.  

  • Card Holder Authorization

    I, the above-named authorized credit card user, give Janelle & Co. Travel LLC. and its representative express authorization to charge my credit card for the purposes detailed above. I understand that this form constitutes a legally binding contract and that by affixing my signature to this form, I will be held responsible for all agreed upon (as stated above) charges as well as any and all collection and legal fees. This credit card is authorized for only the charges noted above. By signing this "Credit Card Authorization" form, I/my organization acknowledge receipt and understanding of its contents, including its "Explicit Authorization" clause.

  • Disclosure and Consent

    We make every effort to honor the package price quoted originally, however; under certain circumstances your price may be subject to increase prior to full payment due to an increase in the cost for one or more of the travel components of your package. We will always notify you in such an event.

    Prices will not increase after you make full payment, except for charges resulting from increases in government-imposed taxes or fees. 

    By signing below, you expressly acknowledge your acceptance of these conditions applicable to your purchase and by signing your name and initials you have read and agreed to this being your signature by electronic transfer to Janelle & Co Travel LLC.


  • By signing below, I agree to the accuracy of the information disclosed within this form and to the authorization to charge my credit card for the amount specified above.

  • Clear
  • Reload
  • Note: Your card will not automatically be charged by completing and submitting this form; however, completing and submitting this form does give the agent the right to charge the card for the amount and purpose authorized above.

  • Thank you for your business!

  • Should be Empty: