旅遊付款資料表(CCruise Payment Form

(Fill out one form for each Credit Card Payment)  (請用英文大

校友中文姓名  _______________________  高三班級或者肄業班級: _________________

Phone電話:  ____________________   email:  ____________________________   

Credit Card Information信用卡資料

Name (As appears on Card) 信用卡上姓名:   ______________________________________

Credit Card Number信用卡號: ____________________   Exp. Date(MM/DD/YY)過期日: ___________

Billing Address信用卡地址(用英文) :   _____________________________________________

用同樣此卡支付船費尾款? (Due by 4/24/2017) (Y/N) _____________

用此卡支付以下參加者費: 

No

護照姓名 Passport Name

(Last, First, Middle)

Date of Birth (MM/DD/YY)

北一女1975 校友(Y/N)

1

2

3

4

5

6

7

8

報名費

每人金額

人數

總金額

北一女1975 校友人數

$0

$

非北一女1975 校友人數

$20

$

訂金

10/14/2016前報名訂金金額$100

$100

$

10/14/2016後報名訂金金額為船費金額20%

$

Total

$

I authorize payment using the credit card information above:

Signature:    ____________________________ Date:  _________________

我們一律用信用卡收 報名費及船費訂金如果妳可以用傳真請傳真fax Theresa, (909) 920-3693再用 EMAIL或 LINE通知她 不然報名後三日Theresa會電話或Line 與妳聯絡

報名費由Theresa 代收,船費訂金會付給Princess Cruises,所以你的信用卡對帳單會列出兩筆。特別提醒最好用美國的銀行發行的信用卡,或確定信用卡不會收Foreign Transaction Fee。不然得多付此額外費用。

請注意:此表資料不可 email  (This form contains confidential information and should NOT be emailed)

Theresa Lock,  Air Sea Travel

theresal_tl@yahoo.com

1655 North Mountain Ave., Suite 115, Upland, CA 91784

Tel: 1 (909)981-1755, cell: 1 (909)816-7876, fax 1 (909) 920-3693

LINE & WeChat ID: 909-816-7876