NAME OF PROPERTY:

CARD NUMBER:

EXPIRATION:

FOUR DIGIT SECURITY CODE:

NAME AS IT APPEARS ON THE CARD:

BILLING ADDRESS FOR CREDIT CARD:

PHONE NUMBER FOR CREDIT CARD:

SIGNATURE OF CARD HOLDER:

This form will be kept on file for the year 2012. Please advise me if there are any credit card changes so we can update our records accordingly. I will need a copy of this in my office before any tickets can be processed. I will accept a fax to expedite the ticketing process, but need the original copy for my records.

Please call me with any questions. This form will avoid any unauthorized charges. Thank you for taking the time to complete this form.

Yours in Travel,

Susan B. Peavey.

Important notice regarding e-Tickets

These tickets are non-refundable once issued. Return date changes are subject to a $150.000 change fee. Please call our office for any changes.