TRAVELER 2:  

NAME:  ______________________________________

ADDRESS:  ___________________________________

CITY: ­­­­­­­­­­­­­­______________________    STATE: ________

COUNTRY: __________________ ZIP: _____________

PHONE:

__________________________           ___________________
HOME                                                CELL

EMAIL:  _______________________________________

DATE OF BIRTH: _______________________________

PASSPORT NO: _________________________________

COUNTRY OF ISSUE: ____________________________

ISSUE DATE: ___________  EXPIRATION DATE: ________

EMERGENCY CONTACT:  ___________________________

CONTACT PHONE:  _____________________________

RELATIONSHIP:  ________________________________

 

 Palace Travel, Inc. ~ 5301 Chestnut Street -Philadelphia, PA. 19139
Toll Free: (800).683.7731 Office: (215) 471.8555 Fax: (215) 471.8898
(w) www.palacetravel.com ~ (e) info@palacetravel.com