JADAR Travel & Cruise Online Group Booking Form

STATE ROOM SELECTION SUMMARY
Category 4B - Quad: $421.73 per person

Enter verified information for all passengers as requested below. Fields with "*" are required

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.		Name must match legal documention (Driver's License, Passport, Birth Certificate etc.) you will provide before boarding. You will not be allowed to board unless your name matches exactly. For example, if Robert Smith is printed on your Passport, Do not enter "Bob Smith".
Address *
Address 2		Dinner Seating * Early Late
City *		Need Insurance * Insurance is optional but highly recommended Yes No
State *		Special Medical Needs * Enter Medical Needs (ie. Wheel chair accessibility, Service Animal, pregnancy, etc.) in the Comment field below. Yes No
Zip Code *		Special Dietary Needs * Enter requests for Special Dietary Needs (ie. Bland diet, vegetarian, etc) in Comment field below. Yes No
Phone Number *		Pay in Full * Paying in full will charge your credit card the full amount on the first payment date. Yes No
Emergency Contact *
Date of Birth * First passenger in each state room must be over 21 years old on date of sailing
Email Address *

BILLING INFORMATION - Only Credit Card Payment accepted

Card Holder Name (as it appears on the credit card) *
Card Type *
Card Number *
Exp Month *
Exp Year *
CV# * Card Verification number for Visa, Master Card and Discover is the last 3 digits to the right of card number on front of card. On AMEX, it is the last 4 digits on the top right of the signature side
Card Holder Address (as on card statement) *
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 field below
AGREEMENT * You MUST authorize payment through charging your credit card for this booking to be processed. Bookings without this express authorization will NOT be processedI authorize JADAR Travel & Cruise and/or Traverus to submit my Credit Card information for payment for the amounts listed and the dates listed for the listed Cruise Passenger

Passenger Name *		Name must match legal documention (Driver's License, Passport, Birth Certificate etc.) you will provide before boarding. You will not be allowed to board unless your name matches exactly. For example, if Robert Smith is printed on your Passport, Do not enter "Bob Smith".
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 - Only credit card payment accepted
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 - If you would like to make a dinner seating request, or have any special dietary or medical needs, please enter this information in the field below
Agreement *I authorize JADAR Travel & Cruise and/or Traverus to submit my Credit Card information for payment for the amounts listed and the dates listed for the listed Cruise Passenger

Passenger Name *		Name must match legal documention (Driver's License, Passport, Birth Certificate etc.) you will provide before boarding. You will not be allowed to board unless your name matches exactly. For example, if Robert Smith is printed on your Passport, Do not enter "Bob Smith".
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 - Only credit card payment accepted
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 - If you would like to make a dinner seating request, or have any special dietary or medical needs, please enter this information in the field below *
Agreement * Bookings without credit card charge authorization will not be processedI authorize JADAR Travel & Cruise and/or Traverus to submit my Credit Card information for payment for the amounts listed and the dates listed for the listed Cruise Passenger

Passenger Name *		Name must match legal documention (Driver's License, Passport, Birth Certificate etc.) you will provide before boarding. You will not be allowed to board unless your name matches exactly. For example, if Robert Smith is printed on your Passport, Do not enter "Bob Smith".
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 - Only credit card payment accepted
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 - If you would like to make a dinner seating request, or have any special dietary or medical needs, please enter this information in the field below
Agreement * You must authorize credit card payment for your booking to be processed. Bookings without this authorization will not be processedI authorize JADAR Travel & Cruise and/or Traverus to submit my Credit Card information for payment for the amounts listed and the dates listed for the listed Cruise Passenger

Type the following: For security purposes, please type the letters in the image.
Verify information and press Submit button once to complete booking