|
|
||||
|
Please
fill out the following information and enclose & enlarge a photocopy
of:
1. Credit Card - Front 2. Credit Card - Back 3. Valid photo ID for verification |
|
|
Organization
Name
|
_____________________________________
|
|
Address
Street
|
_____________________________________
|
|
City
|
_____________________________________
|
|
State
|
_____________________________________
|
|
Zip
|
_____________________________________
|
|
Tel
|
_____________________________________
|
|
Fax
|
_____________________________________
|
|
E-mail
|
_____________________________________
|
|
CEO/M.D./CFO
|
_____________________________________
|
|
Travel
Coordinator
|
_____________________________________
|
|
Primary
Charge Account Information
|
|
|
Credit
Card Number
|
_____________________________________
|
|
Expiration
Date
|
_____________________________________
|
|
Issuing
Date
|
_____________________________________
|
|
Billing
Address Street
|
_____________________________________
|
|
City
|
_____________________________________
|
|
State
|
_____________________________________
|
|
Zip
|
_____________________________________
|
|
I
/ we authorize use of the above card (s) for travel related arrangements
for the following personnel: (Last Name / Middle Name / First Name / Title)
|
|
|
1.
__________________________________
|
2.
________________________________
|
|
3.
__________________________________
|
4.
________________________________
|
|
5.
__________________________________
|
6.
________________________________
|
|
7.
__________________________________
|
8.
________________________________
|
|
9.
__________________________________
|
10.
_______________________________
|
|
By
signing below, I acknowledge charges for all travel related arrangements
made through Arrow Travel & Tours for staff / associates of our organization
_________________________________________________________________.
Payments
in full to be made when billed or in extended payments in accordance with
standard policy of company issuing card and am aware of applicable restrictions
and / or penalties. Tickets are nonrefundable and are subject to a service
fee.
|
|
Card
Holder's Signature(as it appears on the card)
|
______________________________
|
|
Date
|
_________/_________/___________
|