Booking
Number:
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Departing Date: (mm/dd/yy) |
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All
Passengers Names
as they Appear on Passports:
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Card
Holder Name:
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Please be advised that your credit card
is subject to be charged in parts for the amount authorized
below.
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Card
Holder Billing Address:
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Address: |
City: |
State: |
Zip:
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Credit
Card:
(Check one)
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American
Express
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Discover |
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Visa |
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Master
Card
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Credit
Card Number:
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Credit
Card CCV Number:
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CCV
Number?
click here for more information
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Credit
Card Expires:
(mm/yy)
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Contact
Information::
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Day
Time
Ph:
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Cellular
Ph:
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Night
Time
Ph:
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E-mail: |
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Final
Payment:
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If
we cannot confirm services as per quote, we will send
you a new invoice/confirmation form. If the final amount
changes we will require a NEW credit card form with
the adjusted amount.
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Card
Holders Signature:
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Travel
Insurance:
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I
have been advised of and chosen to
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ACCEPT or |
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DECLINE |
Travel
Insurance.
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Shipping
Address:
Documentation is sent by FEDEX requiring a signature
upon receipt. We do not ship to PO BOX addresses.
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Company
or Name:
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Attention/
Care of:
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Address: |
City: |
State: |
Zip:
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