Maritimes Coastal Wonders Form
travel date: 9/26/2018 territory: M6
Maritimes Coastal Wonders featuring the Cabot Trail
For Reservations Contact: Tracy Wilson or Ken Meyer (812) 682-4477 email: email@example.com
Lifestyle Tours, 700 State Route 269, New Harmony, IN 47631-9517
A deposit of $500 per person is due upon reservation. A second deposit of $1,000 per person is due by March 19, 2018. If you purchase our Travel Protection Plan, the deposit is only $250 per person plus the cost of the Insurance. Reservations are made on a first come, first served basis. Reservations made after the deposit due date of March 19, 2018 are based upon availability. Final payment due by July 26, 2018. Deposits are refundable up until March 26, 2018.
YOUR INFORMATION: Clearly print your full name (first/middle/last) as it appears on your government issued travel documentation.
We strongly recommend that you have a valid passport with 6 months validity after the tour return date for all travel outside the United States.
IMPORTANT: In order to avoid any unnecessary change fees, it is imperative that all guest names are entered correctly from the start. The information below must be the legal name and be 100% identical to the ID being used to travel <passport/driver’s license> including middle names or suffixes <Jr, Sr>.
First: Middle or Initial: Last: Suffix:
Nickname: Gender: ( ) Male ( ) Female Date of Birth: month day year
Address: City: State: Zip Code:
Phone: ( ) Cell: ( ) Email Address:
Passport Number: Expiration Date: (month/day/year) Date of Issuance: (month/day/year)
City, State, Country of Issuance: Citizenship:
Should you become ill or injured, whom should we contact (not traveling with you): Phone: ( )
ROOMING WITH: £ Check if address is the same as Passenger #1
First: Middle or Initial: Last: Suffix:
AIR GATEWAY: Departure airport for this tour:
Air Seat Request: ( ) Aisle ( ) Window ( ) Next To Traveling Companion
Collette cannot guarantee your seat preference. If you have not purchased air through Collette and wish to purchase transfers, you must transfer at our pre-scheduled times.
Please be advised, when travelling as part of a group, many airlines do not provide seat assignments. Preferred seating may be available for an additional charge.
“Federal law forbids carriage of hazardous materials such as aerosols, fireworks, lithium batteries & flammable liquids aboard the aircraft in your checked or carry-on baggage. A violation can result in 5 years’ imprisonment and penalties of $250,000 or more. Details on prohibited items may be found on TSA’s “prohibited items” web page: http://www.tsa.gov/traveler-information/prohibited-items.”
Travel protection: ( ) Yes, I wish to purchase travel protection $240 ( ) No, I decline
If you choose not to purchase Collette's Waiver Insurance Plan, you will incur penalties for changes and cancellations. Travel Protection Payment is due with first deposit. The Waiver Fee does not cover any single supplement charges which arise from an individual’s traveling companion electing to cancel for any reason prior to departure. The single supplement will be deducted from the refund of the person who cancels. (There is coverage under Part B which includes a single supplement benefit of $1,000 for certain covered reasons. See Part B for details.)
ON TOUR ACTIVITIES: Please choose one of the following on tour activities
( ) Ice Cream Shop
( ) The Cheese Shop
PLEASE MAKE CHECKS PAYABLE TO: Lifestyle Tours ( ) Check ( ) Credit Card
Waiver/Insurance Amount: $___________________ Deposit Amount: $___________________ Total amount enclosed: $___________________
Cardholder Name (if paying by Credit Card):
Cardholder Billing Address: £ Check if address is the same as above
Cardholder Phone: Amount: $
Credit Card Number: ________________ Expiration Date:____
Signature Required for acceptance of the below conditions and agreement to credit card use:
I agree to pay according to the card issuer agreement. I understand and accept the cancellation policy, terms and conditions. See http://www.gocollette.com/about-collette/terms-and... for full terms and conditions of your purchase.
Important Conditions: Your price is subject to increase prior to the time you make full payment. Your price is not subject to increase after you make full payment, except for charges resulting from increases in government-imposed taxes or fees.
162 Middle Street
Pawtucket, RI • 02860
Phone: 1-800-852-5655 Fax: 1-401-727-9014
If paying by credit card, please complete this form and return to Lifestyle Tours. We can only charge your credit card for the amount noted if the signature, address and phone number are listed below. Thank you!
CREDIT CARD AUTHORIZATION FORM
BOOKING NUMBER: 795648
TOUR: Maritimes Coastal Wonders featuring the Cabot Trail
DEPARTURE DATE: September 26, 2018
GROUP NAME: Lifestyle Tours
Name of Passenger:
Salutation:______ First Name:__________________ Middle Initial:____ Last Name:_________________ Suffix:____
(Mr., Mrs., Rev.) (Please print as it appears on Passport) (Jr., Sr.)
Cardholder Name: _________________________________________________________________
(Please print as it appears on your Credit Card)
Cardholder Address: _______________________________________________________________
(as it appears on your credit card statement)
Cardholder Phone: _________________________________________________________________
Credit Card Type:
___American Express ___Discover ___MasterCard ___Visa
Credit Card Number: _______________________________________________________________
Expiration Date: ___________________________ Amount to be charged: $ ___________________
Cardholder’s Signature: ____________________________________ Date: ___________________
I agree to pay according to the card issuer agreement. I understand and accept Collette cancellation policy, terms and conditions.
Participating credit card companies are now requiring a billing address and phone number for FRAUD PREVENTION. All information MUST be provided. Thank you for your cooperation!
If using your credit card for payment, please return this Authorization Form by mail to:
Attn: Tracy Wilson
700 State Route 269
New Harmony, IN 47631-9517
Or by Fax to: (812) 682-3627
¨ Above credit card information has been called in to Collette.