BOOKING REQUEST FORM (for travel or cruise agents only)
Travel Agency Name
*
Agency Phone #
*
Agent Direct line or Ext #
IATA/CLIA/TIDS #
*
Agent Name
*
Agent E-mail
*
Booking Information:
Cruise N Stay Package
--please select--
ALASKA SAMPLER
ANAHEIM
ANAHEIM & SAN DIEGO
LAS VEGAS
LAS VEGAS & ANAHEIM
LAS VEGAS & LAUGHLIN
LAS VEGAS & SAN DIEGO
LAUGHLIN
MEXICO COASTAL
MOTHER'S DAY CRUISES
PACIFIC COAST CRUISES
SAN DIEGO
Ship
--please select--
CORAL PRINCESS
GOLDEN PRINCESS
ISLAND PRINCESS
SAPPHIRE PRINCESS
AMSTERDAM
OOSTERDAM
RYNDAM
STATENDAM
ZAANDAM
ZUIDERDAM
NORWEGIAN PEARL
Departure Date
--please select--
APRIL 2010
MAY 2010
Departure City
--please select--
Vancouver
Other - please specify below
If other, please specify
Deviations (if any)
Cabin Category
--please select--
Inside
Outside
Balcony/Verandah
Mini Suite/Verandah Suite
Dlx. Verandah Suite (HAL)
Price requested (before tax)
Cabin request
--please select--
Guarantee
Assignment
Cabin assignment requests
Cabin upgrades accepted?
--please select--
Yes
No
Dining requests
--please select--
First
Second
Personal/Open/Freestyle
Table size
--please select--
2 (request only)
4
6
8
Bedding requests
--please select--
1 bed
2 beds
Cross reference (ie: SMITH)
Special occasions (if any)
Dietary requests (if applicable)
Any other booking requests
Passenger Information:
Passenger #1
(full legal name as it appears on VALID passport):
First Name
*
Last Name
*
Age or Birthdate
Past passenger #
Passenger #2
(full legal name as it appears on VALID passport):
First Name #2
Last Name #2
Age or Birthdate #2
Past passenger #2
Passenger #3
(full legal name as it appears on VALID passport):
First Name #3
Last Name #3
Age or Birthdate #3
Past passenger #3
Passenger #4
(full legal name as it appears on VALID passport):
First Name #4
Last Name #4
Age or Birthdate #4
Past passenger #4
Payment Information:
(1 or 2 day OPTION bookings available if outside 90 days)
Amount $
Type of payment
--please select--
Cheque/WRA
Credit Card
1 or 2 day OPTION (not available within 90 days of departure)
Cheque/WRA #
Credit Card #
Expiry date (ie: MM/YY)
Name (as it appears) on card
If you using 2 payments fill here:
Amount $ #2
Type of payment #2
--please select--
Cheque/WRA
Credit Card
Cheque/WRA #2
Credit Card #2
Expiry date (ie: MM/YY) #2
Name (as it appears) on card #2
Please enter symbols from the picture above