800-683-7731
Reservation Form: (PLEASE PRINT)
Enclosed is my Groupon voucher No. ______________________________________________
and payment for $ ______________. See below the options I’m purchasing. I’d like to hold __________ place(s) on the Tanzania Classic Safari.
Final payment due date is 65 days prior to departure. I wish to depart on (CHECK ONE):
Trips for $3,276
[ ]March 21- 29
[ ]March 28 – April 5
[ ]April 18 – April 26
[ ]April 25 – May 3
[ ]May 2 - 10
[ ]May 9 - 17
[ ]May 23 - 31
Trips for $3,384
[ ]March 31 – April 8
[ ]November 10 - 18
[ ]November 17 – 25
[ ]November 27 – Dec. 5
Trips for $3,554
[ ]August 31 – Sept 8
[ ]September 1- 9
[ ]September 29 – Oct. 7
[ ]October 6 - 14
[ ]October 20 - 28
Please make check payable to Palace Travel, Inc. and mail to 5301 Chestnut Street, Philadelphia, PA 19139.
To charge payment to credit card, the Credit Card Authorization form needs to be completed and returned to Palace Travel via mail, email or fax.
1) NAME (As appears on passport): Mr. Mrs. Ms. ____________________________
2) NAME (As appears on passport): Mr. Mrs. Ms. ____________________________
1) ______________________________________
2) _____________________________________________
STREET ADDRESS:
CITY: _______________________________________________________________________
STATE: _________________ ZIP:______________________________________
PHONES:
HOME: _______________________________
OFFICE: ____________________________
CELL: ______________________________________________________
E-MAIL ADDRESS: _______________________________________________________________
FAX: ____________________________________________________
I certify that I have not recently been treated for, nor am I aware of any physical or other condition or liability that would create a hazard to myself or the other members of this tour.
The two of us above are sharing a room and, where possible, would like a room with: ONE TWO Beds (Make one selection only)
I am sharing with _______________________________________________________________________(Form sent separately)
I need assistance in securing a roommate. I understand if Palace Travel cannot locate one for me by the final payment date, I agree to pay the additional single supplement amount.
I prefer to share with: Smoker Non-smoker
I desire single accommodations, if available, and will pay the single supplement additional cost of: $495 per person
I/We wish to participate in the following options at an additional per person cost of:
Optional Balloon Safari $485 additional per adult
Extra nights in Arusha. I wish to have ___ extra nights in Arusha. Cost is $169 per single room; $245 per double/ twin room
I understand international airfare is included from Washington, DC, via Ethiopian Airlines. Please make domestic round-trip air reservations
for me from my home city: _________________________________ to connect with the Ethiopian flights and let me know the additional cost.
Please send me information on air upgrades for: Business Class
Airline Seating Preference: Aisle Window
Frequent Flier # ___________________________________________
**We can request a seating preference on your behalf, however this is only a request and NOT guaranteed, as some seating assignments may be airport check-in only. Requests should be made in writing no later than 60 days prior to departure. Bulkhead and/or emergency row seats can only be requested at airport check-in on the day of departure. Also note that even if we do obtain your preferred seat, it is not guaranteed that the seat will be provided during check-in as there might be equipment changes that nullify our selection.
Optional Insurance – Palace Travel Recommended Insurance
Yes, I wish to purchase insurance now
No, I will purchase insurance at a later date or provide my own through another source.
No refund is possible for unused Groupon voucher. Other penalties in accordance with the policy outlined in the accompanying Conditions of Travel.
WE STRONGLY RECOMMEND THAT YOU OBTAIN TRAVEL INSURANCE. RESERVATIONS ARE ACCEPTED SUBJECT TO TOUR CONDITIONS AND WILL BE CONFIRMED ONLY IF ACCOMPANIED BY COMPLETED FORM SIGNED BY THE TOUR PARTICIPANT(S). YOU MUST PROVIDE A COPY OF YOUR PASSPORT ALONG WITH THIS RESERVATION FORM TO ENSURE THE COMPLETION OF YOUR RESERVATION.
SIGNATURE: ______________________________________________________
DATE: ________________________________
SIGNATURE: ______________________________________________________
DATE_________________________________
PALACE TRAVEL INC.
5301 Chestnut Street, Philadelphia, PA 19139
Tel: 1.215.471.8555; 1.800.683.7731
Fax: 1.215.471.8898
Email :info@palacetravel.com
CREDIT CARD PAYMENT AUTHORIZATION
Please Note: If you wish to charge your deposit to Visa, MasterCard, American Express or Discover, this authorization form MUST be completed and returned to us along with your reservation form before we can process your application.
I authorize (Palace Travel Inc.) to charge my VISA/MASTERCARD/ DISCOVER/AMEX listed below:
Name appearing on credit card: _________________________________________
Card number Expiration date: ___________________________________________
Card Verification Number* Card Type: _________________________________
Billing address of credit card” ___________________________________________
Amount of transaction: __________________________________________________
Services rendered/Items purchased: ___________________________________
Phone number: ___________________________________________________________
Signature: _________________________________________________________________
Date ______________________________________________________________
*How To Locate Your Card Verification Number:
(Visa, MasterCard, Discover: Locate the credit card number on the back of the card above the signature box. Enter the 3 digit number which follows the credit card number. American Express: Enter the 4 digit number found directly above and to the right of the credit card number.)
I understand that all rates quoted on this tour I’m making a payment on are based on tariffs and value of foreign currencies in relation to the U.S. dollar in effect as of December 23, 2011, and are subject to change. No refund is possible for unused Groupon voucher. Other penalties in accordance with the policy outlined in the accompanying Conditions of Travel.
Your Groupon voucher is non-refundable. For all extensions and optional items purchased through Palace Travel, the following penalties apply:
WE STRONGLY RECOMMEND THAT YOU OBTAIN THE OPTIONAL INSURANCE POLICY. INFORMATION WILL BE SENT TO YOU UPON RECEIPT OF RESERVATION FORM.
PLEASE NOTE: At times, our bank requires photocopies of credit card (both sides) and government issued identification, in order to process the charge.
While it is not required at this time that you include these materials with your deposit, if our bank requests it, we will contact you for these copies.
PALACE TRAVEL INC.
5301 Chestnut Street, Philadelphia, PA 19139
Tel: 1.215.471.8555; 1.800.683.7731
Fax: 1.215.471.8898
Email :info@palacetravel.com
TELL US ABOUT YOURSELF:
In order to better serve you, we would like to know more about you. Please complete this form and return it with your reservation form, copy of
passport and credit card authorization form, if applicable.
I am departing on (date): __________________________________________
Name (as it appears on passport): ___________________________________
Gender: Female Male
Address:____________________________________________________
City/State: _________________________________________________
Zip: _______________________________________________________
Email: _____________________________________________________
Phone -
Home: ____________________________________________________
Cell: _____________________________________________________
Work: _____________________________________________________
Date of Birth (M/D/Y): _______________________________________
Passport No.: _______________________________________________
_______________________________
Date/Place of Issue: ________________________________________
Expiration Date: ___________________________________________
Nationality: ______________________________________________
A visa is required for entry to Tanzania. You are responsible for obtaining that documentation.
Please list the following here:
Country of Visa: _________________________________________________
Visa Number: ___________________________________________________
Date of Issue: __________________________________________________
Expiration: ____________________________________________________
Seating Preference: ______________________________________________
Frequent Flyer Carrier & No: ______________________________________
**We can request a seating preference on your behalf, however this is only a request and NOT guaranteed, as some seating assignments may be airport check-in only. Requests should be made in writing no later than 60 days prior to departure. Bulkhead and/or emergency row seats can only be requested at airport check-in on the day of departure. Also note that even if we do obtain your preferred seat, it is not guaranteed that the seat will be provided during check-in as there might be equipment changes that nullify our selection.
Emergency Contact Person (Name/Address/Phone): _____________________________________________________________________
Are you taking any medications at the present?
If so, what?: __________________________________________________________
_____________________________________________________________________
Do you have any allergies? If so, please list. ________________________________
Do you have any medical conditions (i.e.heart condition, asthma, back injuries, recent surgeries, diabetes, pregnancy, etc.)
____________________________________________________________________
Do you prefer non-smoking accommodations? Yes No No preference
Do you have special food requirements? Strict Vegetarian Vegetarian (can eat seafood) No red meat other (please specify)
Other: __________________________________________________________________
I understand the provisions indicated for this tour under the “Conditions of Travel” section and guarantee that the personal information provided on
this form is accurate.
Signature
________________________________________
Date
________________________________________
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