TRAVEL ARRANGEMENTS FORM

Please complete the information below. An agent will contact you regarding your travel needs via phone or email.

(Items marked with * are required)

TOUR INFORMATION
Tour Name * Tour Code Booking Number
Tour Begins (mm/dd/yyyy) * Tour Ends (mm/dd/yyyy) *  
 

TRAVELER INFORMATION
* First name, middle name, and last name must be exactly as it appears on your passport.
First Name * Middle Name * Last Name * Date of Birth *
(mm/dd/yyyy)		 Gender * Passport #

Date Expires
(mm/dd/yyyy)

 Citizenship
Total number of travelers:
For additional travelers, use space below and include same information as above.
 

HOTEL RESERVATIONS

Travel-On is also pleased to offer proprietary rates at a host of hotel properties in Miami, including the Pullman, near Miami International Airport. Special rates are available on a limited basis when you book through Travel-On.
PRE TRIP: Check In Date: # of Nights:
POST TRIP: Check Out Date: # of Nights:
Room Type: Bed Type
 

AIRLINE RESERVATIONS
Be sure to include your preferred flight information if applicable.
OUTBOUND FLIGHT
Requested Arrival Date:* Time:
From (city / airport):*
To (city / airport): *
Preferred Airline / Flight:
Class of service:
RETURN FLIGHT
Select Return Date: Time:
From (city / airport):
To(city / airport):
Preferred Airline / Flight:
Class of service:

FREQUENT FLYER INFORMATION
Traveler Name Airline / Frequent Flyer Airline / Frequent Flyer Seating preference:

SPECIAL REQUESTS
Wheelchair assistance required:    
Special meal request:
Other:

CONTACT INFORMATION
Name: *    
Primary Email * Primary Phone: *
Secondary Email: Secondary Phone:
Address: City:
State/Zip: Country:

EMERGENCY CONTACT INFORMATION (Required by airlines.)
Name: Relationship:
Primary Phone: Secondary Phone:
Address: Email:
City: State/Zip:
Country:

PAYMENT INFORMATION

I hereby authorize Travel-On to charge to the credit card account(s) as indicated on this form, for any travel transactions requested by the traveler.
Credit Card Type: Card Number Exp Date Name on card
Authorized by ( your name): Today's Date (mm/dd/yyyy):    
   

ADDITIONAL COMMENTS