Please enable JavaScript in your browser to complete this form. Agent Code: *Today's Date *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Customer Name *FirstLastCo buyerFirstLastStatus *MarriedSingleLiving TogetherCombined Income75000-8500085000-95000100.000 +Phone *By clicking (YES) below. *Yes! I/We would like to receive future vacation offers. By checking this box, I/We expressly consent and request that Vacation Club VIP LLC and its related and affiliated entities contact me at the number(s) provided using an automated telephone dialing/selecting system, prerecorded message, electronic mail, or SMS text message, regardless of any prior election to the contrary. I/We acknowledge and agree that I/We are not required to sign this agreement as a condition of purchasing any property, goods, or services.Email *AddressAddress Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeAll-Inclusive DestinationsPuerto Vallarta MX.CozumelPunta Cana DR.Cayman IslandsPuerto RicoJamaicaCosta RicaColombiaCancunTulumLos CabosCuracaoDo you know your travel dates? *YesNoCheck-in Date:Check-out Date:All-Inclusive Caribbean/International Package Plan5 Days 4 Nights - $499.005 Days 4 Nights (VIP) - $698.00Booking Fee *Price: $56.00Promo Code Apply Payment Information Cardholder Name *Card Number *Expiration Date *CVV Code *Billing Zipcode *Do you authorize Vacation VIP Club to process a one-time package activation fee? *YesNoReservation Acknowledgement *I acknowledge that I have been rewarded a wholesale discount on my vacation package with the condition of attending a 90 minute presentationI understand guest(s) must attend with their spouse or legally single.The guest(s) have an annual combined income of at least $80000+ or $65000 if single.I acknowledge that if I fail to complete the scheduled resort preview/presentation while on my vacation, I will be charged a penalty of $600 USD to my card on file.I acknowledge that I have 30 days from purchase date to cancel without any penalty or obligation. I understand that a refund request must be emailed to reservations@vacationvipclub.com.I acknowledge that this reservation is non-changeable or cancellable after receiving final confirmation during the verification/welcome call, within 30 days of arrival date. If a medical emergency emerges, I will need to provide medical proofI understand I must bring a valid Drivers license or passport and 2 valid Major Credit cards to check-inTHIS ADVERTISING MATERIAL IS BEING USED FOR THE PURPOSE OF SOLICITING SALES OF TIMESHARE INTERESTS OR PLANS. * Clear Signature SignatureSubmit