EmailMe Form - BREATHLESS @ CABO- BEST OF TWO WORLDS

Full Name *

EXACTLY as it appears on your passport

Date of Birth *

MM / DD / YYYY

If registering roommate also , please provide DOB . IF roommate registering separately then please do not answer.

If traveling outside of the United States , please answer the following

Are you an US Citizen? *

Yes

No

Passport Number *

*You may place a random nine numbers if you do not have a passport*

PLEASE NOTIFY YOUR TRAVEL AGENT IF YOU DO NOT HAVE A PASSPORT

Passport Expiration Date *

MM / DD / YYYY

Name of Roommate(s) or place NA if wish to have single occupancy *

ROOMMATE -Date of Birth

MM / DD / YYYY

If registering roommate also , please provide DOB . IF roommate registering separately then please do not answer.

Occupancy & Room Type *

Single Occupancy Marina View / $1938-pp

Single Occupancy Xhale Club/- $2345-pp

Single Occupancy Xhale Master/$3004-pp

Double Occupancy Marina View/$1069-pp

Double Occupancy Xhale Club/ $1210-pp

Double Occupancy Xhale Master/$1540-pp

* Rate is PER PERSON- based on a 5 day/ 4 night stay and includes all -inclusive stay at Breathless Resort, transfers and travel insurance*

**Stay one free night in all XHALE level rooms when you stay 4 nights**

Would like to add additional days to your travel? *

Yes

No

Dates of Travel

If you answered yes to the question above, please specify dates between November 4-12 & a REVISED vacation package price will be sent to the email you have provided.

Would you like to add a flight to your package *

**If you elect to add AIR to your vacation package an additional $100 is due PER PERSON within 48 hours of receiving the quote**

Departure City

If you answered yes to the question above, please specify the city in which you would like to fly from

Preferred Airline

Known Travel Number

TSA Pre-check/ Global Entry

Physical Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code

Mailing Address if differs from Physical- ALSO IF TIED TO CREDIT CARD NOTED BELOW

Street Address Address Line 2 City State / Province / Region Postal / Zip Code

Phone *

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

Email *

Roommate email address

Are you interested in a monthly payment plan? *

Once your deposit has been received you will be set up on a recurring payment plan based on your remaining balance and number months to final payment- June 2019

If you elected for a payment plan, please indicate which day of the month you elect your payment to be drafted.

Credit Card Elected to Use for Payment Plan

Please note the credit card noted above will be used for the ENTIRE payment plan. Any requests for modifications should be directed to get-going@lyricsdestinations.com

***CREDIT CARD INFORMATION FOR THE INTIAL DEPOSIT TO BE ENTERED ON THE NEXT PAGE**

Confirm CC

Name as it appears on credit card

Expiration Date

MM / YY

CVC Code

Enter the three digit code found on back of credit card or four digit on front for AMEX only

Physical Limitations

Dietary Restrictions/Allergies