EmailMe Form - Ivery Valued Client Booking Quote Form

Passenger Booking Information
Include Booking Information for up to 3 Passengers.
Please be advised that names entered here MUST be EXACTLY as on proof of citizenship at time of travel. Change or cancellation penalties will apply for misspelled or incorrect names.
Select if you are part of one of the groups below *
What is the travel Destination (Hotel or Cruise Name)
If air travel is included, what is the closest airport? City name is fine)
Include preferences for airline (preferences are not guaranteed)
aisle seating
window seat
Main Cabin seating
Comfort Class
Business or First Class Seating
Arrival Date. *
MM / DD / YYYY
Departure Date *
MM / DD / YYYY
Name of Passenger 1 Names MUST be EXACTLY as on Passport or Traveler ID. THIS IS VREY IMPORTANT *
Prefix First Middle Last Suffix
Passenger 1 Birthdate
MM / DD / YYYY
Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Passenger 1 Contact Number
### - ### - ####
Loyalty Numbers (ie Delta Rewards, Marriott Rewards)
Provide your KTN # or PASS ID # for Airport Clearance
Name of Passenger 2 Names MUST be EXACTLY as on Passport or Traveler ID. THIS IS VERY IMPORTANT
If booking single, complete Passenger 1 section only. *
Prefix First Middle Last
Passenger 2 Birthdate
MM / DD / YYYY
Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Passenger 2 Contact Number
### - ### - ####
Passenger 2 Loyalty Numbers that apply to this booking (ie Delta Rewards, Marriott Rewards)
Provide your KTN # or PASS ID # for Airport Clearance
Select any promotional qualifiers that may apply
US. Military (Retired or Active)
First Responder /Fire Department
Age 55+ (any occupany in cabin)
Past Guest of Cruise Line
If Past Guest, include which cruise line in extra information box below.
3rd Passenger if needed. Skip this if you are booking double occupancy. Names MUST be EXACTLY as on Passport or Traveler ID. THIS IS VERY IMPORTANT. Be aware triple occupancy is based on availability.
Prefix First Middle Last Suffix
Passenger 3 Birthdate
MM / DD / YYYY
Passenger 3 Contact Number
### - ### - ####
Loyalty Numbers (ie Delta Rewards, Marriott Rewards)
Check your preference for Tower Location location
Rainbow -
Tapa
Ali ' i
Check your preference for occupancy *
2 Double Beds
1 Bed - Queen or King
Triple - Double Beds
1 Bedroom Suite
Check all that apply.
Other Services Requested
Gratuities included (Cruise only)
Airport Immigration VIP Services (if available)
Airport Transfers (cruise only)
Accessible Services (Wheelchair, scooter, walker, CPAP supplies, walkin shower etc) . Be aware that Accessible Cabin require a Verification of the Disability that require the accessible cabin.
Other
Must Accept or Decline Travel Insurance *
Accept Insurance (Recommended). I understand the premium is non-refundable.
Decline Insurance - I have been informed of the benefits of travel protection
Trip Disruption/COVID 19 Waiver
Supplier refers to your specific booking and any Sub Suppliers. , I acknowledge I requested BMRoache Travel Group to make one or more travel bookings on my behalf. As the worldwide COVID-19 coronavirus pandemic remains ongoing at this time, I acknowledge that for this reason, and other reasons not reasonably foreseeable at this time, these travel plans may be interrupted or canceled by the supplier providing them, a government entity, or another third party over which Agency has no control. I further acknowledge that the supplier’s own cancellation, rebooking, and refund policies, subject to any applicable law that is now or may later be in effect, will govern my rights and remedies, including my right to receive a refund, in such an event. Moreover, I understand that should I elect to purchase travel insurance, the terms of the policy will dictate whether, and to what extent, coverage for any financial loss may exist under the circumstances. By acknowleging this authorization, I hereby agree to hold BMRoache Travel Group harmless and release it from any and all liability for any damages, including but not limited to monetary losses, I may incur as a result of such interruption or cancellation of these travel plans.I also understand that I am subject to the COVID requirements of the airline, DESTINATION NAME, and the SUPPLIER NAME such as, but not limited to, wearing masks and social distancing.
Travel Insurance Waiver
I am assuming any financial loss associated with my travel arrangements. I understand my travel agent is not liable or responsible for any expenses incurred because of trip cancellation, trip interruption, emergency medical treatment and transportation, loss of baggage and/or personal effects, flight or travel accident, rental car physical damage and/or any other expenses incurred.
Include any other information that should be considered in your booking. i.e preferred locations, double or single bed, early or late dining, want to be near anoither cabin booking.
Email *
I, (name of person completing this form), authorize the Supplier to charge the amount authorized above to the booking for travel related services. *
First Last
Date Time *
MM / DD / YYYY
Checkbox
First option
Second option
Third option
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Passenger Booking Information