Orlando Disney Package FORM

Disney - Orlando Adventure!

By Inter-Mex

This Locks In Your Package!

Your Email Address

Payment Method
We prefer not to take credit cards due to the Mexico Interest rates.
However, if you choose we will accept your credit card with a 5% sir charge.

Credit Card Information

Amount $ *One Time Charge

1. C.C. # * (No spaces or hyphens)

2. Expires * (mmyy or mm/yy)

3. Name * Your Name

4. Name * Issuing Bank

	Amount $	*One Time Charge
1.	C.C. #	* (No spaces or hyphens)
2.	Expires	* (mmyy or mm/yy)
3.	Name	* Your Name
4.	Name	* Issuing Bank

OR
Checking Account Information

1. Name on Check

2. Street Address

3. City, State & Zip

4. Check #

5. Amount

6. Bank's Name

7. Bank's Address

8. Routing # (9 digits)

9. Your Account #

10. All the Numbers

Questions or Comments

Your Internet Signature (Required)
Before submitting your Prize Claim, you must type your full name below. By doing this, you agree to the following:

Remember that your credit card statement will say Get-Aways Inc.

You hereby authorize this Internet Merchant "Get-Aways Inc" to either charge your credit card or to create a bank draft for the amount stated here .

You further agree to pay a twenty dollar service charge if bank draft is returned unpaid by your bank for any reason.

You have read the Terms.
* Please Sign Here

Mexico.... InterMex
100 Francia Suite #111
Col Versallas
Puerto Vallarta, Jal - Mx
Ph. 52-32-24-22-13 ext.111
Fax. 52-32-24-21-76 USA.... Get-Aways Travel Net
Post Office Box 965
400 Mobil Ave. Ste. B-9,
Camarillo, Ca. USA
Ph. (805) 484-9779,
Fax (805) 388-8307

Contact Us: