EmailMe Form - Palazzo's Vacations Client Information

Verification: Name of Resort or Ship Selected

Traveler #1 -----------------------------------------------------

Legal name as on passport

Prefix First Middle Last Suffix

Please check passport if middle name is spelled out or not

Date of Birth

MM / DD / YYYY

Country of Citizenship

USA

Canada

Other

Do you currently have a valid US Passport?

Passport Book

Passport Card

Applying Now

Other Visa

NO Passport - Read Below!

ALERT: It is strongly suggested that all travelers exiting the United States of America, in any form or transportation, have a valid Passport Book. In the event of an emergency, no other documents will be accepted for inbound foreign flights. Travelers are responsible for meeting all document requirements for travel. For complete regulations regarding Passport requirements; visit www.Travel.State.Gov

Traveler #2 -----------------------------------------------------

Legal Name as on Passport

Prefix First Middle Last Suffix

Please check passport if middle name is spelled out or not

Date of Birth

MM / DD / YYYY

Country of Citizenship

USA

Canada

Other

Do you currently have a valid US Passport?

Passport Book

Passport Card

Applying Now

Other Visa

NO Passport - Read Below!

ALERT: It is strongly suggested that all travelers exiting the United States of America, in any form or transportation, have a valid Passport Book. In the event of an emergency, no other documents will be accepted for inbound foreign flights. Travelers are responsible for meeting all document requirements for travel. For complete regulations regarding Passport requirements; visit www.Travel.State.Gov

ADDITIONAL GUESTS on this reservation.
Please list First, Middle, and Last name, date of birth, and current Passport Status

****************************************

Information for Primary Contact in Traveling Party for confirmations and receipts

Preferred Contact Phone

### - ### - ####

Email

****************************************

In event of an emergency, please list a contact that is not traveling with your party.

Emergency Contact Name

First Last

List someone "Not Traveling" with you

Emergency Contact Phone

### - ### - ####

****************************************

Making Payments

Name as it appears on your card *

First MI Last

Billing Phone Number

### - ### - ####

Card Type

Please enter your full Debit/Credit Card #

Please enter your card number.

Card expiration date

MM / YY

Security Code

3 Digit code on the back of the card.
4 Digit code on the front (if Amex

Cardholder's billing address

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

Payment Amount

$ Dollars . Cents

Deposit is the minimal amount required to initiate reservation. The date of travel, number of paying guests and supplier terms will be factored in computing required deposit amounts.

Would you like to purchase travel insurance?

Yes. I'd like to purchase trip insurance at an additional cost

No, I choose not to protect my purchse.

Important fact: The average out-of-pocket cost of medical emergency transportation outside the U.S. is $25,000!

Please select the option of your choice based on the Insurance plans offered by Palazzo's Vacations. If declined, any penalties or cancellation fees are your responsibility.
*Insurance is provided by a third party company or supplier; in the event of a cancellation, you will be reimbursed the total amount of payments made minus the cost of insurance. *
Refer to your specific insurance plan purchased for coverage information.

Additional Comments

Email