IF YOU CHOSE THIS OPTION TO SUBMIT BY COMPUTER THROUGH SECURE SERVER!

Please note!

IN ORDER TO PROVIDE YOU WITH THE PERSONAL SERVICE THAT CANNOT BE
FOUND FROM OTHER INTERNET TRAVEL SERVICES, AND, TO SECURE YOUR
CREDIT CARD(S), WE REQUIRE THIS APPLICATION TO BE COMPLETED AND FAXED
OR MAILED OR SUBMITTED BY THIS FORM.  YOUR USER NAME AND PASSWORD WILL BE SENT VIA EMAIL. 
USE OUR ONLINE RESERVATION SYSTEM 24 HOURS A DAY - 7 DAYS A WEEK!

IF YOU DO NOT WANT TO SUBMIT BY THIS FORM,  RETURN TO THE MAIL FORM

First Name:
Last Name:
email address:
I would like to be added to the Andetur Brazilian Travel Club email newsletter

Personal Mailing and Billing Address

Street:
City :
State: Zip Code
Country:
Business Phone:
Home Phone:
Fax Phone:

Personal Billing Information

Credit Card Type: Visa MasterCard
Credit Card Number:
Credit Card Expiration Date: (e.g. 12/01)
Authorized Signature:
I certify that I am 18 years of age or older.

You must register with a credit card that has a valid  billing address.

Billing Address on Credit Card

Street:
City :
State: Zip Code
Country: