Client Profile and Booking Information

I hereby authorize Sandra Kopeck of Travel Professionals International (TPI) to charge my credit card as per the agreed upon amount.

*Name exactly as per passport

*DOB

*Booking Date

*Departure Date

*Departure City

Room Category Choice

*Citizenship

*Passport Number

*Passport Expiration Date

Special Request Frequent Flyer Number

*Name exactly as per passport

*Postal Code

Home Phone

Cell Phone

Email Address

*Emergency Contact Name

*Emergency Contact Number

*Name on Card

*Card Number

*Expiry Date

*CVN