Group Additional Payment Form Global Travel International

2600 Lake Lucien Drive, Suite 201, Maitland, FL

32751
Phone: 800-715-4440 / Fax: 866-251-
0977

GROUP SALES AGENT: Tammy Roan

GROUP SAILING DATE: 11/21/2008
NAME: HILLIARD/EDWARDS FAMILY INVOICE #:

I herby authorize Global Travel International, Inc. (GTI) to charge my credit card, and/or submit my credit card directly to the travel
vendor for payment processing. I understand it is my responsibility to contact Global Travel International, Inc. (or my GTI Independent
Travel Agent) a minimum of 48 business hours prior to the payment dates listed to arrange payments on the applicable travel
itinerary.

Failure to contact Global Travel International, Inc. to make the necessary payments, or to process a change or cancellation to the
itinerary, may result in the cancellation of my travel itinerary and may incur additional penalties.

TRAVELER(S) INFORMATION

# M/F FIRST NAME LAST NAME DATE OF BIRTH CITIZENSHIP

1.
2.
3.
4.
5.
Please fax the completed Groups Payment Form to the Global Travel International Groups Department within two
business days of receipt at (866) 251-0977.

PAYMENT TYPE

SECOND DEPOSIT: $ FINAL PAYMENT: $

INSURANCE
PAYMENT: $ ADDITIONAL PAYMENT: $

PAYMENT TYPE:  CREDIT CARD  DEBIT CARD CARD LIMIT:

CREDIT CARD INFORMATION

CVV#
CARD: __ __ __ __ - __ __ __ __ - __ __ __ __ - __ __ __ __ EXP: __ __ / __ __
CARDHOLDER
CARDHOLDER NAME: SIGNATURE:

BILLING ADDRESS: CITY/STATE/ZIP:

DELIVERY ADDRESS: CITY/STATE/ZIP:

PRIMARY EMAIL
PHONE: ALTERNATE PHONE: :

** FOR OFFICE USE ONLY **

PIN #: RES CARD #: SUPPLIER:

Note: Global Travel does not accept checks or money orders for group bookings. Please use a separate form for each
credit card.