Mediterranean Vacations
T
FAM AUTHORIZATION FORM
FAX TO
MEDITERRANEAN VACATIONS WITH A COPY OF YOUR IATAN/CLIA CARD.
TRAVEL AGENT REGISTRATION: __________________________________________
DEPARTURE DATE: _______________________________________________________
DESTINATION: ___________________________________________________________
TRAVEL AGENTS TRAVELING_____________________________________________
__________________________________________________________________________
COMPANIONS/CLIENTS: ___________________________________________________
__________________________________________________________________________
HOTELS/ACCOMMODATION: _______________________________________________
TRAVEL INFO: ____________________________________________________________
GATEWAYS/OTHER: ______________________________________________________
__________________________________________________________________________
NAME: __________________________________________________________________
AGENCY: ________________________________________________________________
STREET ADDRESS: _______________________________________________________
CITY, STATE, ZIP: ________________________________________________________
PHONE: _________________________________________________________________
FAX: ____________________________________________________________________
EMAIL: _________________________________________________________________
PAYMENT INFORMATION
Overnight Check ___ Yes ___ No. Overnight Service Carrier & Airbill#_______________
Check#__________________
Credit card type: Discover___ AMEX___ VISA____ MC____
Name on Card: _____________________________________________________________
#_________________________________________Exp Date: ___________ CVC _______
CC Billing Address: _________________________________________________________
__________________________________________________________________________
Signature_______________________________________Date: ______________________
Must sign and complete accompanying creditcard authorization form within 7 days of this submission.
A deposit of $250 pp is required with the names upon you agree with the confirmation.