LEISURE/CRUISE TRAVEL REQUEST/INQUIRY

1st Passenger Name:

2nd Passenger Name:

Address Line 1:

Address Line 2:

City:

State/Province:

Postal Code:

Country:

E-mail address:

Phone:

Fax:

# in Party:

 Adults:

Children:

Destination:

 Children's Ages:

 

Smoking:

Non-Smoking:

Dates Requested:

Length of Cruise:

Budget:

 per person

 Cruise Only: Cruise+Airfare: Departure City for Airfare:

Accommodations:

Inside Stateroom (no windows):

# of Rooms

Outside Stateroom (oceanview):

# of Rooms

Inside and Outside:

# of Rooms

Stateroom with Balcony:

# of Rooms

Suite or Mini-Suite:

# of Rooms

Perferred Cruise Line:

Preferred ship:

Have You:

Cruised Before?

Yes

No

On this Cruise Line?

Yes

No

Do you

Multiple Staterooms (2-4)

qualify

Group (5+ Staterooms)

for any

Senior Citizens Discount

of these

Military Discount

discouts?

Cruise Line Past Passenger Discount

(check all

LSI Past Passenger Discount

that apply)

Entertainment Coupons

Special Request:

Select the appropriate lifestyle

Age Range:

Couples:

Intimate Getaways

Sociable, Camaraderie

Families:

with small children

with teenagers

Grandparents with grandchildren

Married:

young, sports, party

Broadway shows, entertainment

refined, relaxed, discriminating

Total Elegance:

Exotic Ports

On-board Amenities

Escapes

Groups:

Special Themes

Educational

Civic, Affinity

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