Administration & Accounts Dept.
Latin America Travel, 19 Cusack Close,
Twickenham, Middlesex, TW1 4TB
E-mail: admin@latinamericatravel.co.uk

 
Title
First Name/s
Surname
Nationality
Date of Birth
1
  Passport Number:
Issue Date:  Clique para abrir o calendário.
Expiry Date: 
  Profession/  
Occupation: 
2
  Passport Number:
Issue Date:  Clique para abrir o calendário.
Expiry Date: 
  Profession/  
Occupation: 
3
  Passport Number:
Issue Date:  Clique para abrir o calendário.
Expiry Date: 
  Profession/  
Occupation: 
4
  Passport Number:
Issue Date:  Clique para abrir o calendário.
Expiry Date:
  Profession/  
Occupation: 
5
  Passport Number:
Issue Date:  Clique para abrir o calendário.
Expiry Date:
  Profession/  
Occupation: 
6
  Passport Number:
Issue Date:  Clique para abrir o calendário.
Expiry Date:
  Profession/  
Occupation: 

Contact details
Travel Agent name (when applicable)
Home Address / Agent Address
Booking Ref:
       
 Tour Name / Hotel
Departure Date:
Clique para abrir o calendário.
 No. Of Nights:
Telephone – Home:
       
 Telephone – Work:
Telephone – Mobile:
       
 E-mail:
Address 1:
       
 Address 2:
Address 3:
       
 Town/City:
County:
       
 POSTCODE:
Country:
       
    

Contact details in case of emergency:
Name:
Telephone:

Accommodation required
Twin

Double

Single Triple

Class of Travel
Economy

Business

 First  

Special Occasions
Honeymoon
 Other:
Other requirements: Diet, Smoker/Non Smoker etc.
(please see General information)

On behalf of the above named I accept the terms and booking conditions.

I have read the Booking Conditions and Important Information and understand the Importance of insuring, and enclose £ being a deposit of £150 per person, or applicable amount (or full balance) plus an Insurance premium of £ I am over 18 years of age.

If not taking out our Insurance, please give details of the Insurance cover effected

Name of Insurer
Policy No

Your name and address will be added to our database for marketing purposes and, from time to time, we may send you details of special offers and other promotional material. Your details will not be passed on to a third party.


If you prefer NOT to receive promotional material please indicate here. Data Protection Policy.
I have read, understood and consent to the terms set out in Legendary Journey Ltd. Booking Conditions.

How did you hear of us?
Word of mouth

Advert - Which publication

Other

Email:

_______________________________________
Signed **



Date **
Travel
Agent Stamp**
** For use with printed form.

Please, write the code that you see