CENTRAL BARTER TRAVEL REQUEST 
Please fill in the requested information. 

Barter Company: __________________________________ Account #: _____________________ 

Member’s Name: _____________________________________ Phone #: ____________________ 

Address: ____________________________________________ Fax #: ______________________ 

Name Reservation will be under: _____________________________________________________ 

Check in ___________________Check out___________________# of nights__________________ 

Destination: _____________________Hotel (if known) or area of town: ______________________ 

Number of adults: ___________ Number of Children: ____________ Number of rooms: _________ 

Additional info: (Non-smoking, Double, King, Etc.): _____________________________________

_________________________________________________________________________________ 

IMPORTANT 

All Reservations are subject to availability. Holiday and seasonal blackouts may apply. There are no refunds
or cancellations on any travel once a booking is confirmed. Allow 2 to 3 weeks for booking.  In most cases certificates have to be mailed, and this takes time.

In some cases we must work through other parties and they may charge fees. There will also be 10% cash
booking fee on all reservations made with clients outside Central Barter.

Taxes, Tips and all incidentals are paid in cash.

A credit card is required for booking. Please enter the information below in order to expedite the process.

We appreciate your input on the quality of our client’s goods and services, however quality is judged individually
by the buyer and is the responsibility of the provider. Please take up any complaints concerning quality with the
manager or owner. (Example: the hotel undercooked your eggs.) 

I understand and agree to the guidelines set forth above and want to begin the booking process

VISA/MC/AMEX/#___________________________________________ EXP. ______/_______ 
 
SIGNATURE: _________________________________________ DATE: __________________

Hotel/Motel Confirmation # __________________________ Phone # ______________________

Central Barter Inc.
594 Sawdust Road #300
The Woodlands, Texas 77380
 281-642-2280 Fax 281-367-3622