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Please print name of person traveling:
*
Unit #:
*
Travel Destination:
*
Amount Authorized:
*
I authorize Adventure Travel to charge my credit card for the Holiday Block Leave travel costs as detailed above.
Credit Card Information
Credit Card Ending in (last 4 digits only):
*
Exp Date:
*
Name on Credit Card:
*
Billing Address:
Street Address:
*
City:
*
ZIP:
*
Signature:
*
Date:
*
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Please attach photocopy of your ID and upload with the form OR print form and fax back to 580-353-5393 or 580-250-4018, along with a photocopy of your ID. Please make sure photocopy is legible. Thanks!
Upload photocopy of ID: