Blue Travel, Inc. - RESERVATION FORM - New World Travel Please fax to USA Toll Free: 1-877-605-6888 or Australia: +61-2-9475-4888 Germany: +49-69-3809-9888 . CUSTOMER ADDRESS: (please print) ___ Mr. ___ Mrs. . Last Name: _____________________________________________________ . First Name: _____________________________________________________ . Street: _____________________________________________________ . City: _____________________________________________________ . State, ZIP: _____________________________________________________ . Country: _____________________________________________________ . Tel +Area Code: _____________________________________________________ . Fax +Area Code: _____________________________________________________ . E-Mail: _____________________________________________________ . PAYMENT: Card Type: __ MasterCard __ VISA Valid Until: ______________ . Card Holder: _____________________________________________________ . Full Cardnumber: _____________________________________________________ . This is a legally binding reservation request and I authorize Blue Travel to disclose my personal information to New World Travel. I give permission for New World Travel to charge my credit card accordingly with the appropriate travel costs, incl. all excursions marked below. I acknowledge that I am the authorized card holder of this account. . RESERVATION: City & Hotel: _________________________________________________________ . Alternative: _________________________________________________________ . Arrival Date: ___________________ Departure Date: ___________________ . No. of Guests: ___ Ages of Children: _________________________________ . No. of Rooms: ___ Room Type: ________________ Smoking: __ yes __ no . ADDITIONAL COMMENTS: . . . . . ____________________________________ ___________________________________ City and Date Signature