Atlantic Barter



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tarix27.03.2018
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#34918

2014 atlantic barter logo

Travel Request Form
From:       To: ___________________________
Atlantic Barter 4 Mill Park Ct Suite F Newark, DE 19713 Phone (302) 654-5650 Fax (302) 654-5668

************************************************************************************

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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