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VACATION ONLINE  FORM

YES! I would like to take a Fun Vacation.

You can pay by credit card or check. You will receive your vacation package two weeks from the time we receive approval of your credit card or your personal or company check. You can then make destination and arrival reservations as outlined in the package you will receive.
Title First : M.I.:
Last:
Email:
Street:
City: State:
Zip: Country:

WHICH VACATION DO YOU PREFER?
3 Day - 2 Night $ 200  4 Day - 3 Night $ 400

Pay by: Credit:
Your Credit Card will be charged either $200 for the 3Day/2Night or $400 for the 4Day/3Night vacation depending on which one you select.
Pay by: Check:  
Make it payable to:
J. B. Richard, Vacations and mail it to:
J. B. Richard
PO Box 1513
Cathedral City, CA 92235  
Card Type:  
Credit card #:  
Name on Card:

  Expires:

Year:

Comments & Suggestions: