09/25/2017 10:07:42 PM


*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
2.
$ .00
3.
$ .00
4.
$ .00
5.

$ .00
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 SUMBIT (just one time to avoid duplicate charges).



All amounts listed are in U.S. Dollars

CLICK HERE TO PRINT THIS PAGE FOR YOUR RECORDS PRIOR TO SUBMITTING

PRESS SUBMIT BUTTON ONLY ONCE TO AVOID DUPLICATE CHARGES!

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