Please print form, complete and return to Pilgrim Tours, PO Box 268, Morgantown, PA, 19543
or Fax to Pilgrim Tours at
610 286 6262

Attention Pilgrim Agent:_____________________________________________________________

Destination or Tour name: ______________________________________________________________________

Date(s) of Travel: _________________________________________________________________________________

In lieu of my Credit Card Imprint, I ___________________________________ hereby authorize Pilgrim Tours
                                                   (PRINT NAME OF CARDHOLDER AS SHOWN ON CREDIT CARD)

To charge my:             
_  Mastercard                _  Visa              _  Discover    
Credit Card Number______________________________________ 

Security Code
(3 digits, back of card)___________      Exp. Date: ________________________ 

In the Amount of: $ _________________________________  for payment of travel arrangement for myself and/or

Full Name of Passenger if other than Cardholder: ___________________________________________________

Card Billing Address: _____________________________ City: ____________ State: _____  Zip: _________

Phone No:_____________________________________ Fax No.: _____________________________________

Email: _____________________________________________________________________________________

Signature below indicates acknowledgement of charges described hereon. Payment in full to be made when billed or in extended payments in accordance with standard policy of company issuing credit card.

Cardholder's Signature                                                                                                                       Required Date

    If traveling with a tour:
I decline the insurance offered by Pilgrim and understand the cancellation policy.
_ I may purchase insurance from another source. Insurance premium should be paid at time of deposit.