Travel Request Form
From: To: ___________________________
Atlantic Barter 4 Mill Park Ct Suite F Newark, DE 19713 Phone (302) 654-5650 Fax (302) 654-5668
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Guest Name(s): _____
Company Name: _____________________ Trade Exchange_________________________
Mailing Address: ___ _______ City, State, Zip_____________
Telephone: __________ Email: _______________________________
Requested Destination: ____________ ______
1st Choice Date of Arrival: Departure:
2nd Choice Date of Arrival: Departure:
Total Nights: Total Rooms: Total Beds: __ Size (Bed): _______ #Adults: # Children: Ages: Smoking: Yes No
Special Requests:
Credit Card Information: Card #: Expiration Date:
Cvv: ________ Billing Zip Code:_____________
Name on card:
I understand that my account must be in good standing to file a travel request with Atlantic Barter. All reservations are non-cancelable and non-refundable once confirmed. There are no exceptions to this policy including no-show, which will be billed to your account. I understand that cash fees may be applicable for taxes and/or cleaning costs, as explained to me by the Atlantic Barter Travel representative.
Understanding the above information, I authorize Atlantic Barter to complete this Travel Request.
Signature of AB Member Date
For office Use Only:
Date Approved ____ ____________________ Broker ______________________________
Amount Billed _________________________ Authorization # __________________
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