Credit Card Payment Form

pdf version

Kindly complete this form by filling in the fields, printing the page, and signing. Then either fax or mail to Gate 1 Travel.
We cannot accept electronic submissions.

THIS SECTION TO BE COMPLETED BY THE CARD HOLDER


Passenger name(s):
Reservation #
Amount Agreed: $
Cardholder (print name)
Home Phone
Address
City
 State   Zip 
Card #
Security Code#
   Click here for information on your security code.
Type of Card
Visa Mastercard American Express Discover
Expiration Date

Please initial each box, sign and submit with your payment.
Travel documents will be sent once this form has been received by Gate 1 Travel.

____ I understand that it is my responsibility to obtain the correct travel documentation (passport, visa, identification) for the destination(s) to be visited.

____ I understand that the names printed on this invoice must match exactly the first and last names in each passport. Any discrepancy may result in cancellation, change fees, new and higher airfares or denial of services.

____ I understand that all disputes concerning this contract shall be resolved by binding arbitration according to the then current rules of the American Arbitration Association in PA, and any such arbitration must take place in Philadelphia County, PA.

____ I understand that I have been offered the option to purchase travel insurance. If I purchased supplemental Cancel For Any Reason protection, I must cancel 72 hours prior to departure to qualify for a travel credit under the terms of the program.

___ I understand that Gate 1 Travel is not responsible for penalties incurred for tickets, international or domestic, not issued by Gate 1 Travel due to schedule and/or flight changes.

___ I have read and understood all terms and conditions including the terms of cancellation policies which may be reviewed at www.gutsywomentravel.com/terms.asp. My payment and signature below constitute acceptance of those terms.



Cardholder's Signature


________________________________________________________________________________
Name (printed)
Date

Fax to GATE 1 at 215-886-2228
or mail to: GATE 1 455 Maryland Dr, Fort Washington, PA 19034

Thank You.