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Travel Explore & Repeat The Exotic Way

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PASSENGER INFORMATION FORM

First Name

Last Name

Email

Phone

Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

Country

Date of Birth

Gender

Passport Number

Issue Date

Expire Date

Are you a US Citizens

If you answered no, please list your country of citizenship

Emergency Contact - Full Name

Emergency Contact's Phone

Emergency Contact's Email

Do you take any medication we should know about?

Travel Insurance - Will you be purchasingTravel Insurance?

Yes, I will purchase Travel insurance and provide proof

No, I am willing to take the risk and lost my investment

Please provide a quote

Other

AGREEMENTS & DISCLOSURES

ELECTRONIC SIGNATURE AGREEMENT

Charge Backs*

I agree that I will not engage in any attempts to pursue any charge-backs with my credit card company if my travel plans change.

Acknowledgement of Information Provided *

All names and dates of birth listed above are as they appear on your passport. I understand that if I have provided incorrect information that I may be denied boarding without compensation.

POLICIES

I accept terms & conditionsView terms and conditions

I accept the Refund PolicyView terms of use

Electronic Signature *

I agree that submitting this form is the legal equivalent of my manual signature.

Your Signature

Thanks for submitting! We will get back to you shortly.

McXotic Tours

1078 Shadick Drive Ste E
Orange City, Florida 32763

1-833-623-9749 | 470-642-9336

travel@mcxotictours.com

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Florida Seller of Travel Ref. No. ST15578 – CST 2090937-50 – Washington UBID No. 603189022 – Iowa Registered Agency No. 1202

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