BMD Travel and Tours

Automatic Debit Request

(for Checking & Credit Card Accounts)  
Click for Live Support!

Group Name or
Reservation/Booking #: or
Destination:
Departure Date:  
BMD Reservation Agent:

Name:
Address:
Contact Phone (include area code):
Contact Email:

Method of Payment:   

Credit Card   Check

Frequency:         on

or

the

                                                   

Credit Card Payment:         

Credit Card Type:
Card Holder Name:
Credit Card No:     Exp. Date: /
Billing Address:
Amount: $

I authorize BMD Travel and Tours to charge my credit card for the amount

indicated above:     Yes    No

 

 

Check Payment:

 

*Required

Please enter your customer's name and address. 
*Name
*Street
*City,state zip
Country
Phone number
Please enter your customer's bank name.
Bank Name
Country
REFERENCE * DATE * CHECK NO. * AMOUNT
TO THE 
ORDER
OF		 BMD Travel and Tours
PO Box 673
Hurst TX 76053-7168
817-282-2597
SIGNATURE NOT REQUIRED
Your depositor has authorized this payment to payee.
Payee to hold you harmless for payment of this document.
This document shall be deposited only to the credit of payee.
Signer's Name
AUTHORIZED SIGNATURE
MEMO 
  *Bank Routing Code   *Bank Account Number  
 

 

 Please make sure the name and address you have entered match your bank statement information. The checking or savings transaction will not be accepted unless this information matches exactly.

 

Example of routing number on check

or

Example of routing number on check

  

   

You may also, mail or fax all payments and registration forms, by printing this completed form and mail or fax to:

BMD Travel and Tours  

Attn:  Accounting

PO Box 673

Hurst, TX 76053

Fax: (817) 282-2597

Attn:  Accounting

 

*If paying by check, please mail or fax a VOIDED check for ease of processing.  Thank You.

 

You may also call or email all credit card payments to:

(817) 282-2597 or Toll-Free (877) 406-8820, Ext 87

Email:  payments@bmdtravel.com

 

 

 

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