ESCAPADE CRUISES & TOURS BOOKING FORM
7850 Nine Mile Rd NE, Rockford, MI 49341
Toll Free: 888-775-0288 x241 Direct: 616-874-2594 Fax: 616-874-0126
Web site: www.singlescruises-tours.com
CLIENT INFORMATION
Legal Name: _________________________________________________
Address: _____________________________________________________
Phone: Day-______________________Night-_______________________
Date of Birth: _____________________Gender- male/female___________
Email: _______________________________________________________
Citizenship: USA-__________Passport: #__________________________
Travel Companion Info: ________________________________________
Cruise requested: ______________________________________________
Cabin Type: Inside- _________Oceanview-_________Balcony-_________
Cabin Mate request: Yes/No (OR) Single occupancy cabin: Yes/No
Smoking Preference: Smoking or Non-Smoking ____________________
Past Cruiser Information: _______________________________________
Medical Conditions: ___________________________________________
Flight Request: Yes/No__________________________________________
Hotel Request: Yes/No___________________________________________
Transfer Request: Yes/No________________________________________
Insurance Request: Yes/No__________________
PAYMENT OPTIONS
Checks, Money Orders or Credit Cards are accepted.
Deposits: _______________ Final Payments: ______________________
Credit Card Number: ___________________________________________
Name as on CC: _______________________________________________
Billing Address: _______________________________________________
Comments/Questions: __________________________________________
Reservation Request
