Street Address line 2
State / Province
Postal / Zip code
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 bottomof the form.
All names and dates of birth listed above are as they appear onthe respective
government issued identification for each named person *
I have been advised of potential change/cancellation charges that may be implemented by the supplier and/or agency in the event that I choose to cancel or change my booking after making
the initial deposit either thru this online form or over the phone.
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.
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 Leisure.com
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