BMIT Credit Card Payment Form

PLEASE NOTE THAT OUR SYSTEM WILL NOT ACCEPT DEBIT CARDS.
Please complete the Credit Card Payment Form below and fax back to 425-487-3750 or 800-370-0509.

THE CARDHOLDER MUST SIGN THIS FORM IN ORDER FOR THE CHARGE TO BE PROCESSED.

  • THE CARDHOLDER MUST BE ON OF THE PASSENGERS.
  • I HAVE READ AND I UNDERSTAND THE TERMS AND CONDITIONS.
  • I HAVE REVIEWED MY ITINERARY AND I VERIFY THAT ALL INFORMATION IS ACCURATE.
  • PLEASE CALL 1-800-435-3593 PRIOR TO SUBMITTING THIS FORM, IF ANY INFORMATION IS INACCURATE, INCLUDING BUT NOT LIMITED TO PASSPORT NAMES, TRAVEL DATES & CITY OF DEPARTURE.
  • I UNDERSTAND THAT PENALTIES, TRAVEL DELAYS OR CANCELATIONS MAY APPLY SHOULD ANY CORRECTIONS NEED TO BE MADE.
  • I UNDERSTAND IT IS MY RESPONSIBILITY TO OBTAIN THE NECESSARY DOCUMENTS FOR TRAVEL INCLUDING PASSPORTS AND VISAS.
  • BY SIGNING BELOW I AGREE TO ADHERE TO THE TERMS & CONDITIONS OF THIS TRANSACTION.

    Booking Number: ________________

    Card Holder Name______________________________________

    Card Holder Billing Address- Street_______________________

    City__________________________________________________

    State_____ Zip_____________

    Credit Card #_____________________________ Exp_____

    Visa, Mastercard, Discover & American Express Credit Cards gladly accepted Debit Cards are not accepted.

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

    Card Holders Signature _____________________________________________ Date___________

    I have been advised of and chosen to ___ACCEPT ___DECLINE Lan Vacations 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.

     

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