Please complete the Credit Card Payment Form below and fax back to 1-425-984-8054.

• The cardholder must sign this form in order for the charge to be processed.
• I have reviewed my itinerary and I verify that all information is accurate.
• I HAVE REVIEWED MY ITINERARY AND I VERIFY THAT ALL INFORMATION IS ACCURATE.
• If any information is incorrect, including but not limited to passport, name, travel dates and city of departure, I understand that penalties, travel delays or cancellations may apply should any corrections need to be made. Please call 1-800-927-3876 prior to submitting this form to make corrections.
  
• I have read and I accept the terms and conditions of BMIT.

Card Holder Name: _________________________________________________________________

Card Holder Billing Address: (Street) ________________________________________________

(City) ________________________________ (State) _____(Zip) _______

Credit Card #_________________________________________ Exp _______

Credit Card Identification Number ____________________ (This is located on the front or back of the credit card)

I authorize $_________________________________________(enter amount) to be charged on my credit card.

Card Holder's Signature: ________________________________________________Date____________

I have been advised of and chosen to _____ ACCEPT ______ DECLINE travel insurance. Please note that if you did not book insurance when you submitted your request an additional amount will be due should you wish to add it to your reservation.
FAX THIS FORM TO: 1-425-984-8054