1413 Madison Park Drive Glen Burnie, MD 21061 Tel. 410-STS-9500 Fax 410-STS-9580

Reservation/Room - Payment Breakdown Please Help US Help You The purpose of this form is to ensure that your agency check is applied to each customer correctly, breakdown the room assignments if your booking covers more than 1 room, and outline any additional options your passengers wish to receive. If you have additional information, please include it in the special instructions. Please note that we must have a signed Tour Participant Agreement (TPA) for each and every traveler. We can never have too much information!!!

Agency Name:	_____________________________________		Check #:	_____________________________________
IATAN#/RepCode:	_____________________________________		Check Date:	_____________________________________
Reservation ID:	_____________________________________
Destination:	_____________________________________		Airport:	_____________________________________
Hotel:	_____________________________________		Trip Dates:	_____________________________________

Room #	Customer Number	Customer Name	Signed TPA (yes/no)	Insurance (yes/no)	Meal Plan (yes/no)	VIP Package (yes/no)	Payment Amount

Special Instructions:
Signature:	_________________________________
Print Name:	_________________________________