EmailMe Form - JASCO Travel Questionnaire

JASCO Products Company

Punta Cana, Dominican Republic Sales Incentive Trip Travel Questionnaire

Title: *

First Name: *

As printed on your passport.

Middle Name: *

As printed on your passport.

Last Name: *

As printed on your passport.

Nickname: *

Date of Birth: *

MM / DD / YYYY

Passport Number: *

Passport Expiration: *

MM / DD / YYYY

US Citizen: *

Yes

No

If not a US Citizen, country of issued passport:

Spouse's Information

(if applicable)

Spouse's Title:

Spouse's First Name:

As printed on your passport.

Spouse's Middle Name:

As printed on your passport.

Spouse's Last Name:

As printed on your passport.

Spouse's Nickname:

Spouse's Date of Birth:

MM / DD / YYYY

Spouse's Passport Number:

Spouse's Passport Expiration:

MM / DD / YYYY

US Citizen:

Yes

No

If not a US Citizen, country of issued passport:

Contact Information

Email: *

Phone: *

Address: *

Street Address City State / Province / Region Postal / Zip Code Country / Region

Where you would like your documents to be sent.

Preferred Contact Method: *

Best time to contact? *

HH : MM AM/PM

Airline Service Requirements

Please give us any information we might need to make your airline reservations.(Wheelchair, Diet, Seating Preference, Frequent Flyer Numbers, etc)

Special Instructions:

Frequent Flyer Numbers:

Please separate with commas. (Ex. John Doe 0123456, Jane Doe 0123456, etc.)

Hotel Preferences

Single Bed

2 Beds

Smoking

Non-Smoking

Please check all that apply. Preference granted upon availability.

Emergency Contact

Contact's Full Name: *

Contact's Phone: *

Thank you!

If you have any questions while filling out this form, please contact Karel Ford at 405.206.8982 or 405.848.7666, or by e-mail at kford@hmionline.com.