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.
| Passenger / Client Name(s): | |||||||||
| Reservation # | |||||||||
| Amount Authorized to Charge: $ | |||||||||
| Cardholder (print name) | (If not one of the traveling Passenger(s),Card Holder must submit a copy of the front and back of the card) - Please Print |
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| Address | |||||||||
| City |
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| Home Phone | |||||||||
| Card # | |||||||||
| Expiration Date | |||||||||
| Type of Card |
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____ I have read and understood all terms and conditions including the terms of cancellation policies . My payment and signature below constitute acceptance of those terms. |
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Fax to GATE 1 at 215-886-2228
or mail to: GATE 1 455 Maryland Dr, Fort Washington, PA 19034