EmailMe Form - Rocky Mountaineer Deposit Form

5 South Morton Avenue
Morton, PA 19070
1-800-423-0247
Departure Date *
MM / DD / YYYY
Group Leader *
First Last
Name as it appears on your passport *
Prefix First Middle Last Suffix
The charges to change an incorrect name on documents is $150.00 including FedEx charges
Date of birth *
MM / DD / YYYY
Were you born in the United States? *
Yes
No
If no, what country were you born in ?
Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Phone *
### - ### - ####
Mobile Phone
### - ### - ####
Email
By entering your email address, you will receive an email confirmation of your submission which includes a copy of the completed form.
Passport Number
Date of Issue
MM / DD / YYYY
Date of Expiration
MM / DD / YYYY
Issuing Authority
United States Department of State
Other
If not the US Department of State please enter Other here
Will you be traveling with a roommate? *
Yes
No
Name of Person with whom you will be Rooming
Bed Preference
1 King Bed
2 Double Beds
What special occasion will you be celebrating on your trip?
Is airfare included on this reservation? *
Yes
No
If included, what is the departure city and airport? *
Emergency Contact Person
First Last
Relationship to you
Emergency Contact's Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Emergency Contact's Phone
### - ### - ####
Rail *
Silverleaf
Goldleaf
Your trip includes Silverleaf Hotel Accommodations. Please specify your desired Rail.
Total Cost of Trip *
$ Dollars . Cents
Your credit card will not be charged this amount
Amount of Deposit to secure your reservation *
$ Dollars . Cents
YOUR DEPOSIT IS NON-REFUNDABLE and will secure your reservation.The rest of your trip cost is due by your final payment date.
Arch Roam Right's Travel Insurance
Click here to view Travel Insurance information on our website
Would you like Travel Insurance?
TRAVEL PROTECTION IS RECOMMENDED AND OPTIONAL.

Travel Insurance information can be found on our website *
ACCEPT: I have selected to PURCHASE Travel Protection Insurance as offered by Grand American Tours. I have reviewed the Policy Coverage and accept that the policy meets my desired protection plus I understand all insurance premiums are non-refundable
DECLINE**: I acknowledge that I have received Travel Insurance information and quote; I am WAIVING access to these coverage provisions by DECLINING to purchase the travel insurance offered by Grand American Tours for my travel plans.
**If DECLINING: note that you may be able to purchase limited coverage up to 24 hours prior to travel. Ask your agent for restrictive details. Grand American Tours will not be held liable for any financial losses incurred from failure to purchase insurance coverage. Insurance Premiums are always non-refundable.
Travel Insurance
INSURANCE PREMIUM IS NON-REFUNDABLE.
Contact Grand American Tours for trip costs up to $20,000
Cancellation Policy:

Airfare, pre and post nights, and motorcoach transportation, if included, and any Grand American Tours service fees are non-refundable at the time your final payment is due to Grand American Tours. Rocky Mountaineer cancellation policy is according to the Rocky Mountaineer website. If you are unable to access the Rocky Mountaineer website, please call our office at 1-800-423-0247 for Rocky Mountaineer’s cancellation penalties. Insurance premium (if purchased) is non-refundable. I acknowledge that I have read and agree to the cancellation policies. *
BY CHECKING THIS BOX, I UNDERSTAND AND AGREE TO THE CANCELLATION POLICY AND WOULD LIKE YOU TO CHARGE MY CREDIT CARD
Credit Card

Card Number

Expiration

MM /

YY CVV

What is this? 3 or 4 digit number printed on the back/front of your credit card

Submitting this form authorizes us to charge your credit card for the deposit amount.

Protected in vault Data collected via fields that have our security seal are encrypted and stored with the highest global security standard — PCI compliance. Your data is absolutely safe in Vault.

Arch Roam Right's Travel Insurance