GMT E-check Payment

Order Information

Company name:  
Customer ID:
First name*:   Last name*:
Phone:   Alt phone:
Email:   Alt email:
Name of Person going on the Trip*:
Country Travelling to*:
Departure Date for the Trip*:
Best email to contact the person going on the trip*:
If you have been approved for a discount please enter the type and percentage : 
All discounts and payment plans must be approved by GMT Central Office staff.: 
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Payment Information

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Echeck (ACH) accounts (optional)
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Terms and Conditions

Global Medical Training
2701 E Hill Dr
Rock Falls, IL 61071
(815) 622-1605

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