Print out this page fill in the info
fax to: Dial an International
Operator - enter 523-224-2176.

Please check Your Package!
[ ] 2 Week Vacation Only $180.00
[ ] Airline Tickets Only &180.00,
[ ] Airline Tickets & Vacation $360.00

 Please Check One
[ ] Annual Payment $180.00
[ ] Annual Payment $360.00
[ ] 2 Monthly Payments $95.00
[ ] 2 Monthly Payments $185.00
[ ] 4 Monthly Payments $50.00
[ ] 4 Monthly Payments $95.00
[ ] 12 Monthly Payments $20.00
[ ] 12 Monthly Payments $45.00

 
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

    Your Internet Signature (Required) You agree to the following:
  • I hereby authorize this Internet Merchant "Get-Aways Inc" to create a bank draft for Please Check One; [ ] Annual Payment $180.00 or [ ] Annual Payment $360.00 or [ ] 2 Monthly Payments $95.00 or [ ] 2 Monthly Payments $185.00 or [ ] 4 Monthly Payments $50.00 or [ ] 4 Monthly Payments $95.00 or [ ] 12 Monthly Payments $20.00 or [ ] 12 Monthly Payments $45.00.
  • I further agree to pay a twenty dollar service charge if bank draft is returned unpaid by your bank for any reason.
  • I agree that if I have choosen the monthly payment schedule, should I request my Vacation before all payments have been made, I authorize Get-Aways to issue a bank draft for the balance owed at that time.
  • I have read all the information including the Reservation Information and I fully understand that I am entitled to the Vacation benefits when my matrix is filled.

    * Please Sign Here _____________________