JADAR Travel & Cruise - Booking Form

GROUP TRAVEL BOOKING

Category	Occupancy	Price per Person
4D - Inside View	Double	$485.51

Supply information requested below to complete booking. All fields with '*' are required. Name, address, telephone number and billing information must be correct and verified for a successful booking Email confirmartion and cruise updates will be sent to the email address supplied. Enter only valid email address to receive your booking confirmartion and updates

Passenger Name * Name must match passport that you will provide before boarding. You will not be allowed to board unless your name matches exactly.		Name must match legal document (passport, etc.) you will provide before boarding. You will not be allowed to board unless your name matches exactly.
Address *
Address 2		Dinner Seating * Early Late
City *		Need Insurance * Yes No
State *		Special Medical Needs * Enter medical needs (ie: wheelchair accessability, service animal, pregnancy, medication, etc.) in the comment field below Yes No
Zip Code *		Special Dietary Needs * Enter request for Special Dietary Needs (ie: bland diet, etc.) in the comment field below Yes No
Phone *		Pay in Full * Paying in full will charge you the full amount on the first payment date Yes No
Emergency Contact *
Date of Birth *
Email Address *

BILLING INFORMATION - We accept only Credit Card Payment
Card Holder Name (as it appears on the credit card) * Enter name as it appear on your credit card
Card Type *
Credit Card # *
Exp Month *
Exp Year *
CV# * Last 3 digits on signature panel of Discover, MC and Visa
Card Holder Address (same as on credit card statement) * Enter S/A if same as passenger address
Comment * If you would like to make a dinner seating request, or have special medical and/or dietary needs, please enter this information in the space below.
Agreement *I authorize my travel arranger to submit my credit card information for payment on this cruise

Passenger Name *		Name must match legal document (passport, etc.) you will provide before boarding. You will not be allowed to board unless your name matches exactly.
Address *
Address 2		Dinner Seating * Early Late
City *		Need Insurance * Yes No
State *		Special Medical Needs * Yes No
Zip Code *		Special Dietary Needs * Yes No
Phone Number *		Pay in Full * Yes No
Emergency Contact *
Date of Birth *
Email Address *

BILLING INFORMATION - We accept only Credit Card Payment Card Holder Name (as it appear on credit card) *
Card Type *
Credit Card # *
Exp Month *
Exp Year *
CV # *
Card Holder Address (as on statement) *
Comment
Agreement *I authorize my travel arranger to submit my credit card information for payment on this cruise

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