Name *

First Name

Last Name

Phone *

(###)

###

####

Type of Card *

If Disney gift card, select OTHER

Visa

Mastercard

American Express

Discover

Other

Name on Card *

If Disney Gift Card, just enter your name

First Name

Last Name

Billing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

I give Kimberly Hill/Mouse Tales Travel my permission to charge this card for travel services and/or reservations. *

Yes

No