R E S E R V A T I O N
A P P L I C A T I O N
(Click for a printable application
"Word Document"
"PDF
file"
NAME OF TOUR: _
15
Day Scandinavian Splendor
LAND
& AIR R
/ LAND ONLY *
TOUR DEPARTURE DATE:
July
26th - August 9th, 2006
DEPARTURE CITY:_______________________________
EARLY DEPARTURE/LATER RETURN/EXTENSION REQUESTS
(please indicate extension hotel requests, if applicable):
_________________________________________________________________________________
EACH
person
in party must complete and sign his/her own Reservation Application.
Please observe the following instructions:
a. Type or print
name
exactly as it appears/will
appear in your passport.
For "Title", indicate Mr., Mrs., or Ms.
b. Yes, we do need "Date of Birth" for
each participant.
NAME:
| _______/ |
__________________________/ |
___________/ |
_____________________________ |
| (Title) |
(First
Name) |
(Middle
Name/ Initial) |
(Last
Name) |
ADDRESS:
| ____________________________________/ |
_____________________/ |
_____/ |
____________ |
| (No.
& Street) |
(City) |
(State) |
(Zip
Code) |
PH:
| ______/ |
_______________/ |
_____________________/ |
CITIZENSHIP: |
| (A.C.) |
(Home) |
(Alternate) |
(Country) |
| DATE OF BIRTH: |
PLACE OF BIRTH: |
| (Month/Day/Year) |
(State
and/or Country) |
PASSPORT NO:________________________ ISSUE
DATE:_____________ PLACE OF ISSUE:_________________________
(Passport must be valid for at least 3 months
after return date. You may leave line above blank and advise when you
receive your passport. )
NAME OF
PHYSICIAN:_________________________________________________________________
PH:____ /________________
CLOSEST
RELATIVE:______________________________________RELATION:___________________
PH:____ /_______________
ROOMMATE’S NAME:
_________________________________________________________________________________________
SINGLES
,
if you do not
wish to have a roommate,
check this box * .
If
you would like us to try to find you a roommate,
please answer the following: Do you smoke? YES *
/NO * . Do you mind if roommate smokes?
YES * /NO *
.
May we give your phone number to
possible roommates? YES
*
/NO
*
NAME(S) OF TRAVELING COMPANION(S) (if
applicable): ______Maureen Halsey's Group____________________________
*
Enclosed
is my credit card deposit, plus insurance premium if applicable, of
$___$299.00__________________.
Please
charge my *
Discover *
Visa
*
MasterCard.
(Note:
The cardholder must be the above tour participant.)
Use
this form only for deposit and insurance (see next option for full
payment.)
After
your account number, write the last 3 digits of the Card Validation Code
(found on the signature side of your card).
$___299.00____________,
Exp. Date: _________, Account # ______________________________CVC:
________
I
have read the Image Tours “Tour Contract”, pertaining to this tour,
and I understand and accept its contents, including
“Answers
to Frequently Asked Questions.” (If traveler is under 18, legal guardian must also
sign).
*
I want to pay the entire amount due in order
to guarantee 11/28/05 price. See
Credit Card Authorization Form on page 2.
SIGNATURE OF PERSON TRAVELING
:
________________________________________________________________
.............................................................................(Please
sign full name, as it appears/will appear in your passport)
I FOUND OUT ABOUT THE TOUR FROM: ___
____________________
Terms and conditions are set by: © 2005 by Image Tours, Inc.
Page 2
Price
Guarantee Policy and Credit Card Authorization
Because
our trip will not take place until July 2006 there are many variables that
can affect the final price, including value of the Euro against the US
Dollar and airline fuel costs. Therefore our tour operator IMAGE TOURS can
only guarantee these prices through November 28, 2005. In order to lock
in these prices you must pay the entire price of your tour in full by
11/28/05. If you choose to only pay the $299 deposit at this time the
final price of the tour maybe higher however, your place on the tour will
be reserved . If the final price is more than 6% of our 11/28/05 price you
may request, in writing, a refund of your deposit.
We strongly recommend you use a credit card
for all payments.
CREDIT
CARD AUTHORIZATION
(For use when paying in full)
I,
(print your name as it appears on your card)____________________________,
hereby authorize IMAGE TOURS to apply the amount of
$ ____________to my *
Visa *
Master Card *
Discover
towards charges for the below described passengers and tour:
a)
PASSENGERS NAMES:
b)
TOUR: Scandinavian Splendor
July 26, 2006, Maureen Halsey
Credit
Card Type and Number :_______________________________Security
Code_________
Name
on Card: _____________________________________________
Expiration
Date of Card:
Billing
Address on Card: Street _______________________________
City ________________________ Zip _________________________
Your
telephone number__________________________fax______________________________
Your
email:
_____________________________________________________________________
Your
Signature:
___________________________________________________________________
IMPORTANT:
Please fax a signed copy of this form along
with your application
to:
775-514-1493.
OR
MAIL TO: Rudy & Maureen Wright
232 Cherry Knoll Pl
Frankfort KY 40601
All
Terms & Conditions Established by Image Tours, Inc.
Please
go to our website: MHWTRIPS.com and click on Scandinavian
Tour and then click on
Terms & Conditions. Read
carefully. Call us with any questions.
If
you cannot open this information, please call us and we will send you a
copy.
