Cruise Passenger Vital Information Form
Thank you for entrusting your travel to my agency. In order for me to best serve you, I will need the following information:
Name As It Appears on Passport (passenger 1)
*
First Name
Middle Name
Last Name
Suffix
Cell Number Passenger 1
*
Format: (000) 000-0000.
Email Passenger 1
example@example.com
Date of Birth (passenger 1)
*
-
Month
-
Day
Year
Date
Name As It Appears on Passport (passenger 2)
First Name
Middle Name
Last Name
Suffix
Cell Number Passenger 2
Please enter a valid phone number.
Format: (000) 000-0000.
Email Passenger 2
example@example.com
Date of Birth (passenger 2)
-
Month
-
Day
Year
Date
Will others be traveling with you? If so, please note below with dates of birth:
Address (please use address that is associated with Credit Card used for payment
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
US Citizen? Yes/No
*
Please Select
YES
NO
How many nights would you like to cruise?
*
Please Select
1-5 NIGHTS
6-7 NIGHTS
8+ NIGHTS
First Preference for Travel Date
*
-
Month
-
Day
Year
Date
Second Preference for Travel Date
-
Month
-
Day
Year
Date
Back
Next
What cruise line company are you interested in?
*
Celebrity
MSC
Virgin Voyage
Norwegian
Royal Caribean
Carnival
Princess
Holland
Disney
Other
What type cabin would you be requesting for this cruise?
*
Inside Cabin
Ocean View Cabin
Balcony Cabin
Passenger room type.
*
Single
Double
Triple
Quad
Travel Protection Insurance Accepted?
*
Yes, provide me information on Travel Protection Insurance
No, I do not wish to have Travel Protection Insurance
I already have a Travel Protection Insurance Plan
Do you have a passport? If so, Please provide issue date and expiration date. Please list both/all passengers and passport # for each.
What is the price range you would like to stay within and note if this amount is with or without airfare:
Are you pregnant or plan to be at time of travel?
If you have children traveling with you, will any be under 6 months old at travel date?
Do you have any dietary restrictions? If so, please list.
Do you need an accessible cabin or will you want/require a scooter?
Do you have any reward programs with airlines or cruise lines? If so, please list.
Will you need pre or post lodging or need a car rental at any time during your vacation? How many days/nights?
Are there people that you would like to join you on this trip that I could contact on your behalf? Please list with email addresses or phone numbers
Is there anything else I need to know? Do you have any special needs? Please describe below:(i.e., Medical, Dietary, Limited Mobility, Allergic Reactions, Cabin Assignment Requests, Comments)
Submit
Hazy Days Travel
mark@hazydaystravel.com
217-494-6236
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