Please complete this form and return it to us by fax or mail. Do not submit this form by e-mail. Please include clear, legible photocopies of signature & photo pages of passports for all passengers.
Fax to: 215-572-9803
Mail to: Friendly Planet Travel, Inc., 1 Abington Plaza, 101 Old York Rd., Suite 204, P. O. Box 505, Jenkintown, PA 19046
Name of passenger (if other than cardholder):
_______________________________________________________________________
Your name as it appears on your credit card:
______________________________________________________________________
Card Number _____________________________________ Exp Date _____________
Security (CID) Number __________
(Visa, Master Card, Discover CID # is 3-digit on back of card. AMEX CID # is 4-digit on front of card.)
Billing address for this card (if other than home address):
_______________________________________________________________________
_______________________________________________________________________
I authorize Friendly Planet Travel, Inc. to charge my/our credit card for (circle one):
Deposit Insurance Final Payment** Authorized Amount:___________________
Tour Name: _______________________________________________
Dates of Travel: ____________________________________________
***Please note that we will charge your credit card for the amount indicated above on the day we receive this authorization form.***
I understand that my deposit is non-refundable.
Signature: _________________________________________ Date: _______________
Phone: _________________________
