APPLICATION FORM

To become a Lifetime member of the Prestige Passport to Travel Club 
send only a $99 processing fee (includes S/H).

NAME:  ______________________________________________________________________

ADDRESS:  __________________________________________________________________

_____________________________________________________________________________

CITY: _____________________________________  STATE: ________ ZIP: _______________

WORK #:_______________________________ HOME #:______________________________

FAX #:_______________________________________________________________________

E-MAIL ADDRESS: ____________________________________________________________  

     YES, Please send me special offers and notices via email!

Payment Type:    ______ Check        ______ Credit Card  Make Checks Payable to PTS Travel

Credit Card Type:    ______ Visa     ______ MasterCard       ______ Discover      ______ AMEX

Card #:_______________________________________            Expiration Date: ____________

I understand that the $99.00 processing and shipping fee will be charged to my credit card.

Cardholders Signature: ____________________________________   Date: _______________    

Sponsor: _________________________________________________________  AIN: DT-6603

PTS Representative: ___________________________________________________________                 

Mail or Fax to:  

PTS TRAVEL

4802 Gunn Hwy, Suite 158

Tampa, FL 33624

FAX: (813) 264-5736

DT-6603