Land Booking Form

Name of Group Vacation Event *

Name of Resort or Hotel *

Date of Travel * +

Full Name as it is on your Passport *

Your Email Address *

Phone Number *

People in the Room- Incorrect names that don't match Passports may incur a change fee by the airline

	Name (as on your Passport)	Birth Date	Gender
1st person	Name (as on your Passport)	Birth Date	Gender
2nd person	Name (as on your Passport)	Birth Date	Gender
3rd person	Name (as on your Passport)	Birth Date	Gender
4th Person	Name (as on your Passport)	Birth Date	Gender
5th Person	Name (as on your Passport)	Birth Date	Gender
6th Person	Name (as on your Passport)	Birth Date	Gender

Do you want to add travel protection insurance? Very Important! See Coverage and Rates. *

Yes

No

Need more information

I do hereby authorize CruiseOne to charge my credit card number below, in the amount stated. *

Yes

No

Room Type (see options on your group web page) *

Amount to Charge: *

Credit Card Type

Credit Card Number

CID #

Expiration Date

Electronic Signature of the person on the credit card *

Address *

City *

State *

Postal Code *

Please automatically charge my card when the final payment is due. *

Yes

No

Comments:

Agency Name: CruiseOne-The Green Group
Agent Name: Kim Green
Telephone: 800.874.0405

IATA #: 504-29-643
Fax: 704.257.0233
E-mail: kgreen@cruiseone.com

Land Vacation Booking Credit Card Authorization Form

Land Vacation Booking
Credit Card Authorization Form