DATE:                         AGENT:   

SUPPLIER:        DESTINATION:       CONF. #: 
DEPOSIT DUE DT:        FINAL PMT DUE DT:      COMMISSION DUE:                                                                                                           TOTAL PRICE P.P. (INCL TAX):    
PAX 1:        PAX 2:   
PAX 3:        PAX 4:   
DEPARTURE DATE:        RETURN DATE:        DURATION (NTS)   
HOTEL OR SHIP NAME:       

OUTBOUND FLT   CARRIER:      FLT #      DATE:      DEPT TM:     ARRV. TM

RETURN  FLT     CARRIER:      FLT #      DATE:      DEPT TM:     ARRV. TM

BASE PRICE P.P. (W/O TAX):     TAX P.P.         TTL PRICE P.P.    

WAS INSURANCE TAKEN?    YES NO     INSURANCE COST P.P.:   

LEAD PAX ADDRESS:    STREET
                                              CITY/ST/ZIP
                                              PHONE

TYPE OF PAYMENT MADE:    DEPOSIT FINAL PAYMENT         CALLED IN TO SUPPLIER?  YES NO

IF CREDIT CARD-- ACCT #     EXP DT 

DID YOU COVER CANCELLATION WITH THE CLIENT?                        YES NO
DID YOU COVER PAYMENT DATES AND REQUIREMENTS?             YES NO
DID YOU HAVE THE CLIENT SIGN A PASSENGER CONTRACT?    YES NO
DID YOU HAVE THE CLIENT SIGN A "UCC" FORM?                             YES NO
DID YOU CALL IN THE PAYMENT TO THE SUPPLIER AND CONFIRM ALL NAMES?  YES NO
DID YOU COVER PROOF OF CITIZENSHIP REQUIREMENTS WITH THE CLIENT IF APPLICABLE? YES NO

DOES THE CLIENT HAVE ANY SPECIAL NEEDS?  IF SO LIST THEM   

ANY SPECIAL OCCASIONS?  LIST THEM: