RESERVATION FORM

Please carefully read and complete this form, sign, and fax ++84.4.3927 4118 or scan and send over the e-mail to sales@LuxuryTravelVietnam.com or mail to LUXURY TRAVEL CO., LTD - 05 Nguyen Truong To Street, Ba Dinh Dist, Hanoi, Vietnam

CONTACT INFORMATION

Full name: ______________________________________________________________________________

Your Mailing Home Address: ________________________________________________________________

Phone (business): ___________________________Phone (home):_________________________________

Fax: _______________________________________ Email: ______________________________________

Name of Emergency Contact: _______________________________________________________________

Relation: ____________________________________ Phone: _____________________________________

TRIP INFORMATION

Trip Name: __________________________________ Trip Code: __________________________________

Trip Date: ______________________________________________________________________________

Accommodations: double room, double twin room, I prefer single accommodation at supplemental cost

Arrival Date: _________________________________ Flight No. & Arrival Time_______________________

Departure Date: ______________________________ Flight No. & Departure Time: ___________________

Special Requirements (eg. vegetarian, diabetic, allergies, medical conditions etc.) :

______________________________________________________________________________________

PASSPORT INFORMATION

Full Name of first passenger(as it appears on passport): _________________________________________

Full Name of second passenger(as it appears on passport): ______________________________________

Citizenship: ___________________________________ Occupation: ______________________________

Passport No: __________________________________ Date of Birth: _____________________________

Issue Date: ____________________________________ Expiration Date: __________________________

PAYMENT INFORMATION

(Reservation 60 days before departure date) I am paying a NON REFUNDABLE deposit of $ 100 per person to LUXURY TRAVEL Co., Ltd and if reservation made within 60 days before departure date, the full payment is required upon confirmation by:

Bank transfer, Cash, Credit card (Charge to: Visa, Master card, Amex )

Name as stated on credit card: ____________________________________________________________

Credit Card No: ________________________________Expiration Date: ___________________________

ID Card ( the last three-digit number appearing on signature panel ):(Example)_______________________

Credit card Issuing Bank __________________________________________________________________

I authorize LUXURY TRAVEL Co., Ltd to debit the TOTAL AMOUNT of US$_________________________

Please provide a copy of two sides of your credit card into the below box.

I have read, understood, and accept the Terms and Conditions as stated in the agreement and release and discharge LUXURY TRAVEL Co., Ltd and its representatives from and against any liability arising from participation on the tour.

Signature: ________________________________________________ Date: ________________________