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High Life Travel Group LLC Booking Form
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Destination
*
Primary Traveler Information
Name
*
First
MI
Last
Date of Birth
*
MM
/
DD
/
YYYY
Email
*
Contact Phone Number
*
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-
###
-
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Airline Rewards/Membership #
Please Select Room Choice:
Double Occupancy
Yes
No
Triple Occupancy
Yes
No
Please enter additional traveler's name as it appears on travel documents
First
MI
Last
Date of Birth
MM
/
DD
/
YYYY
Email
Airline Rewards/Membership #
Please enter additional traveler's name as it appears on travel documents
First
MI
Last
Date of Birth
MM
/
DD
/
YYYY
Email
Airline Rewards/Membership #
Flight Options:
Window Seat (If Available)
Yes
No
Aisle Seat (If Available)
Yes
No
Food Allergies
Yes
No
Do your need wheelchair assistance?
Yes
No
I prefer First Class Seating upgrade (Additional cost will apply to booking)
Yes
No
Travel Documents:
*
Yes, I have a valid U.S. passport
No, I will obtain a valid U.S. passport prior to travel
N/A, U.S. passport is not required for my travel
Additional Comments or Questions:
Travel Protection Insurance:
*
Yes, voucher travel protection (Credit for future travel)
Yes, refund travel protection
No, I decline travel protection
Payment Information:
Deposit Information:
*
Full Deposit
Full Trip Amount
Payment Amount:
*
Credit Card
*
Card Number
Expiration
MM
/
YY
CVV
What is this?
3 or 4 digit number printed on the back/front of your credit card
Protected in vault
Data collected via fields that have our security seal are encrypted and stored with the highest global security standard — PCI compliance. Your data is absolutely safe in Vault.
Billing Address
*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Aruba
Bahamas
Barbados
Belize
Canada
Cayman Islands
Cook Islands
Costa Rica
Cuba
Dominica
Dominican Republic
El Salvador
Grenada
Guatemala
Haiti
Honduras
Jamaica
Mexico
Netherlands Antilles
Nicaragua
Panama
Puerto Rico
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Trinidad and Tobago
United States
Argentina
Bolivia
Brazil
Chile
Colombia
Ecuador
Guyana
Paraguay
Peru
Suriname
Uruguay
Venezuela
Albania
Andorra
Armenia
Austria
Azerbaijan
Belarus
Belgium
Bosnia and Herzegovina
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Faroe Islands
Finland
France
Georgia
Germany
Greece
Hungary
Iceland
Ireland
Italy
Kosovo
Latvia
Liechtenstein
Lithuania
Luxembourg
Macedonia
Malta
Moldova
Monaco
Montenegro
Netherlands
Norway
Poland
Portugal
Romania
San Marino
Serbia
Slovakia
Slovenia
Spain
Sweden
Switzerland
Ukraine
United Kingdom
Vatican City
Afghanistan
Bahrain
Bangladesh
Bhutan
Brunei Darussalam
Myanmar
Cambodia
China
East Timor
Hong Kong
India
Indonesia
Iran
Iraq
Israel
Japan
Jordan
Kazakhstan
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Lebanon
Malaysia
Maldives
Mongolia
Nepal
Oman
Pakistan
Palestine
Philippines
Qatar
Russia
Saudi Arabia
Singapore
Sri Lanka
Syria
Taiwan
Tajikistan
Thailand
Turkey
Turkmenistan
United Arab Emirates
Uzbekistan
Vietnam
Yemen
Australia
Fiji
Kiribati
Marshall Islands
Micronesia
Nauru
New Zealand
Palau
Papua New Guinea
Samoa
Solomon Islands
Tonga
Tuvalu
Vanuatu
Algeria
Angola
Benin
Botswana
Burkina Faso
Burundi
Cameroon
Cape Verde
Central African Republic
Chad
Comoros
Democratic Republic of the Congo
Republic of the Congo
Djibouti
Egypt
Equatorial Guinea
Eritrea
Ethiopia
Gabon
Gambia
Ghana
Gibraltar
Guinea
Guinea-Bissau
Cote d'Ivoire
Kenya
Lesotho
Liberia
Libya
Madagascar
Malawi
Mali
Mauritania
Mauritius
Morocco
Mozambique
Namibia
Niger
Nigeria
Rwanda
Sao Tome and Principe
Senegal
Seychelles
Sierra Leone
Somalia
South Africa
Sudan
Swaziland
United Republic of Tanzania
Togo
Tunisia
Uganda
Zambia
Zimbabwe
Country / Region
Payment Authorization:
*
I authorized Donald E. Williams(High Life Travel Group) to process full per person itinerary cost to my card.
I authorized Donald E. Williams(High Life Travel Group) to process deposit only per person to my card.