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FROM: ____________________________________________ TO: ____________________________________
I, the undersigned, _________________________________________________________________________
Authorized to charge my ______________________________________________________________________
Card Number __________________________________________________________________________________
Expiration Date ____________________________
Security Code Number ____ ____ ____ ____
For the amount of US $ _____________________
Cardholder's signature ________________________________ Date ____ / ____ / ________
Billing address: ___________________________________________________________________
City: ___________________________ State: ________________ Zip: _________________
Phone: (_____) __________________________________ Fax: (_____) __________________________________
 
Important Notice:
  • If you are paying for someone other than yourself, please print the full name of the passenger and clarify the connection of passenger with cardholder. Passenger's name(s)______________________________________________________________________
  • Credit Card will not be processed without clear copies of front and back of the card and copy of driver's license.
  • Restrictions and penalties apply to all airline tickets, land/ tour packages and cruises.
  • We strongly recommend Travel Safe vacation insurance. For more information please visit  our website: www.travel4lessonline.net

 










 


Phone: 301.977.4141 • E-mail: liz@travel4lessonline.net
  
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