JADAR Travel Cruise Booking Form

Booking Form

STATE ROOM SELECTION SUMMARY
Category 6C- Double Occupancy $541.73 per person

Supply information requested below to complete booking. All fields with '*' are required.

Passenger Name * Name must match exactly the name on your passport. If name does not match you may not be allowed to board
Address *
Address 2 Apart number, Suite number, etc		Dinner Seating * Early Late
City *		Need Insurance * Optional but highly recommended insurance for your cruise Yes No
State *		Special Medical Needs * Enter Special Medical Needs (eg. Wheel Chair access, Service Animals, Pregnancy, Medication, etc) in the comment field below if you selected Yes option Yes No
Zip Code *		Special Dietary Needs * Enter Request for Special Dietary Needs (eg. Bland Diet, vegetarian, etc) in the comment field below if you selected Yes option Yes No
Phone Number * If we have any question or problem with your booking, we will contact you at this number. Please enter correct number		Pay in Full * Paying in full will charge you the full amount on the first payment date Yes No
Emergency Contact * A phone number of an emergency contact (person not traveling with passenger) is required for booking
Date of Birth * First passenger in each state room must be 21 or older
Email Address * Confirmations will be emailed to this email address. Ensure it is current and verified

Address *
Address 2		Dinner Seating * Early Late
City *		Need Insurance * Optional but highly recommended Yes No
State *		Special Medical Needs * Enter Medical Needs (eg. Wheel Chair access, medications, etc) in the Comment field below if you selected Yes Yes No
Zip Code *		Special Dietary Needs * Enter Request for Special Dietary Needs (eg. Bland diet, etc) in the Comment field below if you selected Yes Yes No
Phone Number * Enter current and verified number where we can reach you		Pay in Full * Paying in Full will charge your credit card the full amount on the first payment date Yes No
Emergency Contact * Phone number of an Emergency Contact (person not traveling with you) must be supplied to complete booking
Date of Birth *
Email Address *

BILLING INFORMATION - Only credit card payments 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

Type the following: For security purposes, please type the letters in the image.
Verify information and then click Submit to process your booking