2005 Pleasant Holidays AirPass Application

 

Applicants Name As It Appears
on Drivers License
(please print or type)
1
 
2
 
3
 
4
 
5
 
6
 
2004 AirPass Number (if member) _________________________________
Existing Member Rate $2,499 TOTAL= $________________________
New Member Rate $2,799 TOTAL= $________________________
Phone Number ________________________________
Address:_____________________________________

City:__________________________, State ____________________________,
Zip_____________
 
E-mail Address _______________________________
** Booking Changes Allowed By Members on This Application - Please Initial For Approval Initial 1 _______Initial 2______  Initial 3______

Initial 4______ Initial 5______ Initial 6______
Signature Accepting Terms & Conditions
Signature Accepting Terms & Conditions
Signature Accepting Terms & Conditions
Signature Accepting Terms & Conditions
Signature Accepting Terms & Conditions
Signature Accepting Terms & Conditions
 
 
 
 
 
 
Date_____________________________________  

Total number of renewal passes being purchased ________ at $2,499 per pass for a total of $_______________.

 

 

Total number of new passes being purchased ________ at $2,799 per pass for a total of $_______________. Maximum of 2 new members per Pass holder

To Purchase by Credit Card: Please supply the following information and mail this form to Island Splendor Vacations C/O
Michael's Travel Centre, Inc. at the address on bottom of page. By signing and . mailing in this form, purchasers agree to 2005 AirPass terms and Conditions

________________________________________

Credit Card Holders Name

 _______________________________________________

Credit Card Holders Signature

 

 

_______________________________________
Credit Card Number

  

 _____________________________________________
Expiration Date

 

Credit Card Holder’s Billing Address:
(street, City, State, Zip) 		 

 

 

 

If using a credit card, the above card will be charged with the amount listed above. If any of the above
pass holders are paying with a separate credit card or by check, please indicate how each pass holder
is paying.

If paying with a separate credit card, please copy this form, have the person complete the credit card
information and attach to the original application.

To Purchase by Check: Please make checks payable to Michael's Travel Centre, Inc. and mail to:
Island Splendor Vacations C/O Michael's Travel Centre, Inc., Accounting Department, 2772-B
Townsgate Road, Westlake Village, CA 91361

**By initialing on this column, you give any Pass holder who has also initialed on the same column
under this application; permission to make, change or cancel bookings in the call center or on the Internet site for you.