Jewish Travel Division of EMCO Travel, LLC Since 1993 Toll-free 877-466-2934.  Phone 727-254-4373 Fax: 203-653-5586 email:  info@JewishTravelAgency.com

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Print out this form and fax it back to us at 203-653-5586

I, the undersigned (Print Name)    authorize E&M Travel to charge my credit card representing payment for 
booking number (if avaialble)      for the following services: 
To charge the amount:    To my:Visa      Mastercard    AMEX 
                                 
Credit Card Number :   Security Code:    Expiration Date:

Print Name   Signature_________________________________  Date:

E-mail:  

Billing Address:

City:    State   Zip:

Billing Phone:

I/We are aware of any cancellation policies and agree not to dispute or attempt of Chargeback any of the above signed for and acknowledged charges.
Cardholder Initial ________
                               
 
VERY IMPORTANT: Please be advised that your Credit Card statement will show EM Travel 
 

Toll-free 877-466-2934.  Phone 727-254-4373
email:  info@JewishTravelAgency.com
www.JewishTravelAgency.com

EMCO Travel LLC, DBA Jewish Travel Agency is registered with State of Florida as Seller of Travel Registration No. ST36902
California Travel Seller # 2079011-40
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