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)

____ Private service @ ______________ = ______________

                                                   Subtotal = ______________

                                 4% Processing Fee = ______________  (Non-refundable)

                                                    TOTAL = ______________

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
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