Information Request Form

Vacation Description

Vacation Type:

Tour Name:

Tour Code (if applicable):

Hotel Standard:

Room Type:

Is this your first trip to the South Pacific?:

yes no

What countries would you like to visit this trip?

Australia	New Zealand
Fiji	Tahiti
Cook Islands	Samoa
Tonga	Vanuatu
Papua New Guinea

Description/Comments:

Flight Information

Departure City:

Preferred Departure Date:

Preferred Return Date:

Passenger Information

Name(s) (as it appears in your passport):

Age:

Number of Adults:

Number of Children:

Ages of Children:

Travel Budget per Person:

Contact Information

First Name*:

Last Name*:

Address 1*:

Address 2:

City*:

State*:

Zip Code*:

Home Phone*:

Work Phone:

Fax Number:

Email*:

I would like to receive information about Newmans Travel Deals:

(Please note: Your personal information will remain confidential at all times and will only be used to update you on our products and services. We respect your privacy)

Additional Information

Please contact me by:

Best time to call:

If you have a Preferred Travel Agency, please complete the following:

Travel Agency:

Name of Travel Agent:

Travel Agent Phone Number:

Travel Agent Email:

Comments/Questions