PEP Offer – Registration Form Your request is to be sent duly completed via email to: de-sales@airmalta.com / at-sales@airmalta.com / ch-sales@airmalta.com Date of application Name & Surname of travelling applicant Name & Surname of accompanying person (if any) Name of Agency Address Address IATA number Telephone numbers e-mail address Departure date (option 1)
Departure date (option 2)
From
To
Return date (option 1)
Return date (option 2)
From
To
Please include one of the following ID cards: IATA/Service ID card
Filekey/Record Locator For KM internal use only Credit Card Payment Please tick Eurocard/Mastercard Visa Other Credit Card Nbr. Incl. Security Code Expiry date I hereby authorize Air Malta to debit my credit card account accordingly Place / Date Name of Car Holder (block letters) Signature I/We hereby confirm that the applicant is an employee of our agency/Place,
Date……………………………………………………….
Stamp/ Signature……………………………………………