PAYMENT FORM Please utilize this form to make your initial and monthly payments. If you have any questions, comments or concerns, please do not hesitate to contact us at 609-326-3682 or travelbymontara@gmail.com Select Your Room Category: --Select One-- TRAVELERS MUST USE THEIR LEGAL NAMES AS THEY APPEAR ON THEIR PROOF OF CITIZENSHIP TO REGISTER Traveler one Gender ---Please Select--- male female other U.S. citizen ---Please Select--- yes no Date of Birth Traveler two Gender ---Please Select--- male female other U.S. citizen ---Please Select--- yes no Date of Birth Traveler three Gender ---Please Select--- male female other U.S. citizen ---Please Select--- yes no Date of Birth Traveler four Gender ---Please Select--- male female other U.S. citizen ---Please Select--- yes no Date of Birth BILLING & TICKETING INFORMATION (P.O. Boxes Not Accepted) Card Type VISA MC AMEX DISCOVER Expiration Date Month January February March April May June July August September October November December (+)add another card PAYMENT INFORMATION Card Type: -Select- VISA MC AMEX DISCOVER Expiration Date Month -Select Month- January February March April May June July August September October November December Year CVV Number Amount to Pay Now: $ (+)add another card ADDITIONAL INFORMATION OR SPECIAL REQUEST