Wine Cruise Request Form

"The Essence of Burgundy and Provence"
Reservation Request Form

Full, Legal Name(s) as it appears on a valid U.S. Passport is required

* Indicates required field

Primary Contact Name *

First

Last

Phone # *

Email *

Street Address *

City *

State *

Zip *

Passenger 1 Full, Legal Name *

Passenger 1 Date of Birth *

Passenger 2 Full, Legal Name *

Passenger 2 Date of Birth *

Stateroom Type Desired *

Stateroom Occupancy *

Would you like us to assist in your air transportation arrangements? *

Yes No

If "Yes", from what airport? *

Special Requests or Comments *

THIS CRUISE REQUIRES A $400 PER PERSON DEPOSIT AT THE TIME OF
BOOKING IN ORDER TO CONFIRM YOUR RESERVATION. UPON RECEIPT $200 PER PERSON IS IMMEDIATELY
NON-REFUNDABLE, AS PER AMA WATERWAYS CANCELLATION GUIDELINES.
ONCE THIS FORM HAS BEEN RECEIVED WE WILL CONTACT YOU TO GO OVER ALL DETAILS.

Name as it appears on your credit card *

Credit Card Number *

Expiration Date *

Security Code *

Submit

"The Essence of Burgundy and Provence"Reservation Request Form

Full, Legal Name(s) as it appears on a valid U.S. Passport is required

"The Essence of Burgundy and Provence"
Reservation Request Form