Client Info and CC

Client Information and Booking Information Form
Contact Information:
Agent Name: David Horowitz
Full Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number *

Area Code Phone Number
E-mail *
Emergency Contact Name *

First Name Last Name
Emergency Contact Phone *

Area Code Phone Number
Travel Information:
Date of Departure *

Month Day Year
Date of Return *

Month Day Year
Departure Airport
Arrival Airport
Name of Resort/Hotel
Booking/Reservation Number
Full names must be listed as they appear on your government issued identification and passport for all travelers. If additional space is needed use the space located at the bottom of the form.

Please include the information of the person completing the form, if that person is travelling.
Passenger Names: (Please List Full Legal Names)
Passenger 1 *

Prefix First Name Middle Name Last Name
Birth Date *

Month Day Year
Passenger 2

Prefix First Name Middle Name Last Name
Birth Date

Month Day Year
Passenger 3

Prefix First Name Middle Name Last Name
Birth Date

Month Day Year
Passenger 4

Prefix First Name Middle Name Last Name
Birth Date

Month Day Year
Passenger 5

Prefix First Name Middle Name Last Name
Birth Date

Month Day Year
Passenger 6

Prefix First Name Middle Name Last Name
Birth Date

Month Day Year
All names and dates of birth listed above are as they appear on the respective government issued identification for each named person *

I agree
Travel Insurance:
I have been advised of the option to purchase travel insurance. *

I agree and understand that my investment is at risk if insurance is not purchased.
Passenger 1 Insurance Coverage *

Accept Decline
Passenger 2 Insurance Coverage (if applicable)

Accept Decline
Passenger 3 Insurance Coverage (if applicable)

Accept Decline
Passenger 4 Insurance Coverage (if applicable)

Accept Decline
Passport/Visa:
I have been advised of passport/visa requirements related to my trip *

I agree
Air Carriers and Baggage:
I have been advised of the actual airline serving each leg of my flight(s), as well as the corresponding baggage policies. *

I agree
Change/Cancellation:
I have been advised of potential change/cancellation charges that may be implemented by the supplier in the event that I choose to cancel or change my booking after making the initial deposit. *

I agree
Disclosure and Consent:

We make every effort to honor the package price quoted originally, however; under certain circumstances your price may be subject to increase prior to full payment due to an increase in the cost for one or more of the travel components of your package.

Prices will not increase after you make full payment, except for charges resulting from increases in government-imposed taxes or fees. *Cruiselines have a right to charge a fuel surcharge, per their policies.

By signing below, you expressly acknowledge your acceptance of these conditions applicable to your purchase and by signing your name and initials you have read and agreed to this being your signature by electronic transfer to Magic Destinations.

http://airconsumer.dot.gov/rules/EAPP_2_FAQ_01-11-2012final.pdf
Signature *

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Additional Comments or Passenger Information
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Should be Empty: