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Please complete this form and return it via email, mail or drop off at our office. With a copy of your Credit Card and any ID (mandatory).

*Travel Agent's Name: _____________________________________________________

*Passenger(s) name:		FAMILY NAME	FIRST NAME
	1.	________________________	________________________
	2.	________________________	________________________
	3.	________________________	________________________
	4.	________________________	________________________
	5.	________________________	________________________

*Itinerary:

Origin:	____________________	Destination:	____________________
Departure Date:	____________________	Return Date:	____________________
Airlines:	____________________

*Cardholder Name: (AS shown on the credit card): _________________________________________

*Credit Card type:

Visa

Master Card

American Express