RESERVATION FORM
(Name exactly as it appears on passport)
Last Name, First Name, Middle

Name
Name
Address
City		State
Zip		E-mail
Phone		FAX
Accommodations	Single Double Tripple	Smoking	Non Smoking

Special Requirements

A $200 (per person) deposit is required by: APRIL 19
($50 is non-refundable)

Please reserve 1 2 3 4 5 6 7 8 9 10 seats for the trip to Ireland. A deduction of $50 can be taken from FINAL PAYMENT if paid by cash, check or money order.

I authorize Prestige Travel to charge my credit card: American Express MasterCard Visa Other Other

Card Number Exp. Date

a deposit in the amount of

If this form doesn't work or you have any questions please call 1-800-966-5050
and ask for ilona or email ilona@prestigetravelny.com