Payment
Method:
VISA _______ MASTERCARD _______ AMEX _______
�(NO OTHERS)
Credit Card Number:
______________________________________ Expires:
______________
Name As It Appears on
Card:
____________________________________________________________
Travelers Name:
____________________________________________________________
Amount To Be Charged: $____________________________
TRIP DESTINATION / DATE: (PLEASE MAKE SELECTION)
TRIP DATE / DESTINATION - (PLEASE MAKE SELECTION)
TRIP DATE / DESTINATION - (PLEASE MAKE SELECTION)
Dec 05-12 - Vail I
Dec 27-Jan 02 - Copper Mountain
Jan 24-31 - Vail II
Jan 31-Feb 07 - Telluride I
Feb 06-13 - Snowmass
Feb 20-27 - Breckenridge I
Feb 27-Mar 06 - Banff
Feb 27-Mar 06 - Aspen
March 04-11 - Lake Tahoe (Sertoma)
March 04-13 - Alaska
March 13-20 - Big Sky
March 13-20 - Breckenridge II
March 20-27 - Telluride II
Undecided
Card holder acknowledges
receipt of goods and/or services in the amount shown
hereon and agrees to perform the obligations set
forth in the cardholder’s agreement with card
issuer. Cardholder has read and agrees to the
Cancellation Policy on the Bowen Travel Trip
Application. Additional charges will require a
separate authorization.
Cardholder
Signature: __________________________________________
Date: ____________
Cardholder
Billing Address: ____________________________________________________________
City, State, Zip ____________________________________________________________
Daytime Phone: _______________________ Email Address:
_______________________
This verifies information
Date of eMail:
_______________
