Customer Information Form

Australian Tours and Cruises - Client Information Form

Fields marked with an asterisk (*) are required

NOTE: do not fill in this field. It is used to prevent automated unsolicited submission.

Customer Information

Title: *

Family name as per passport/ID: *

Given name(s) as per passport/ID: *

Date of birth: *

Postal address:

Email address: *

Home telephone:

Mobile Telephone: *

Passport information

Passport number:

Date of issue:

Date of expiry:

Scanned copy of passport:

Seating preferences:

Further information

Airline/Hotel/Cruise memberships details:

Special dietary requirements:

Special service requirements:

Number of people travelling in group:

Departure date of tour:

Emergency contact information

Name of emergency contact (person not travelling): *

Relationship to traveller: *

Contact telephone number: *

Email address & postal address:

Final questions

How did you hear about Australian Tours and Cruises:

Subscribe to the Australian Tours and Cruises mailing list?: *

Yes

I agree to the terms and conditions of this booking : *

fIagreetothetermsandconditionsofthisbooking

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