09/09/2024 08:47:44 AM

*Tour Code and Passenger ID Number can be found on your Passenger Billing Statement
PASSENGER ACCOUNT PAYMENT DETAILS
	Passenger Name:	(4 Positions) Tour Code*:	(NOT your Permanent ID) Passenger ID Number*:	(Whole dollar amounts only) Amount to Apply:	Amount Includes Travel Protection?
1.				$ .00	Yes No
2.				$ .00	Yes No
3.				$ .00	Yes No
4.				$ .00	Yes No
5.				$ .00	Yes No
TOTAL AMOUNT TO BE CHARGED TO THE FOLLOWING U.S. CHECKING ACCOUNT:				$ .00

	Funds can only be drawn from U.S. Banks
Bank Routing Number:
Checking Account Number:
Name as it appears on Check:
I authorize Educational Opportunites Tours to initiate a single ACH/electronic debit to the checking account above in the total amount listed. By authorizing and clicking on SUBMIT, I agree that the ACH/electronic check I authorize complies with all applicable law. To authorize and complete this payment process, please check the option below and then click SUBMIT (just one time to avoid duplicate charges). I authorize the transaction described above I DO NOT authorize the transaction above