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Submit Your Credit Card Information to TripGuy
This form is to be used for clients of TripGuy Travel as a way to submit payment for trips booked thru the agents of TripGuy Travel.
Today's Date:
Is this for a vacation Initial Payment or Final payment?
Initial Payment
Interim Payment
Final Payment
TSA Required Passenger Information:
How many passengers?
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2
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First Name
Middle Name
Last Name
Date of Birth
Gender
Passenger 1:
Male
Female
Passenger 2:
Male
Female
Passenger 3:
Male
Female
Passenger 4:
Male
Female
Passenger 5:
Male
Female
Passenger 6:
Male
Female
Passenger 7:
Male
Female
Passenger 8:
Male
Female
Passenger 9:
Male
Female
Passenger 10:
Male
Female
Passenger 11:
Male
Female
Passenger 12:
Male
Female
Reservation Number:
Agent Name:
Name on Card:
Amount:
Card Type:
Visa
Master Card
AMEX
Discover
Card Number:
Expiration Date:
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2010
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2012
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2015
2016
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CC Sec code:
Billing Street:
Billing City:
Billing State:
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District of Columbia
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Virginia
Washington
West Virginia
Wisconsin
Wyoming
Yukon Territory
Billing Zip:
Email:
Phone:
I authorize TripGuy Travel LLC to use the above information to charge my credit card the stated amount. Completion of this form and the initialing of this box signifies acceptance in lieu of my signature.
Your Initialed Acceptance:
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Do you want to purchase Travel protection for this reservation?
Please be aware that you may not be able to purchase
all types of insurance after your Initial Payment is made.
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Fla. Seller of Travel Ref. No. ST37580. California Seller of Travel #: 207 7256-40. California law requires certain sellers of travel to have a trust account or bond. TripGuy Travel LLC has a trust account. Registration as a seller of travel does not constitute approval by the State of California