RESERVATION - PAYMENT FORM
Please print and fill one form per person or group arriving and departing with same
itinerary and hotel. For example, if three persons arrive and depart together in
the same dates and flights to/from the same hotel, use one form with the lead
name. However, if one of these three persons returns on a different date or
flight or from a different hotel, please use two forms. One for the two persons
that travel together round trip and one for the person that although arriving
with the other two persons, has a different departure itinerary.
Name: _________________________ MI: ______ Last: _____________________________
Address: _______________________ City: ___________________St: _____ Zip: ________
Phone: ________________ Fax: ________________ Email: __________________________
#Adults: _______ #Children (under 3 years old): ______
Child Car-Seat? (No) (Bringing Own) How Many: ______
Arrival hotel: ________________________ Departure hotel: __________________________
Arriving date: ____________ Airline & Flight#: _____________________ Time: ___________
Departing date: __________ Airline & Flight#: _____________________ Time: ___________
For updated rates and destinations, please refer to our website, or you can e-mail or phone us.
|___________ Adults @ _____________ = ______________
(2 people minimum)
_________ Children @ _____________ = ______________ (under 3
years w/ Child Car-Seat)
Check number: ___________________ (payable to BAJA GROUND SERVICES, INC.)
I, the cardholder, hereby authorize Baja Ground Services, Inc. to charge the
above TOTAL amount to my:
(VI - MC - AX - DS) Number: _______________________________ Exp. date: ____/_____ Sec. Code: _______
Name on card (if different from above): ____________________________________________________
Billing address (if different from above): ____________________________________________________
City: _______________________________________________ST: _________ Zip: ________________
Cardholder signature: _________________________________________________________________
Please mail or fax this form to: BAJA GROUND SERVICES, INC.
P.O. BOX 171123 - SAN ANTONIO, TX 78217 Tel. (800) 352-4990 & (210) 930-5700 - Fax (210) 930-5707
Vouchers mailed the same day payment is received. Or faxed, if payment is received within 5 days of arrival.
DO NOT HESITATE TO CALL OR E-MAIL US IF YOU HAVE ANY QUESTIONS. www.BajaOnly.com