| Name
Passenger # 1:___________________________________________ |
| Date
of Birth: ____/___/____ Home Phone:_______________ |
| Street
Address Passenger # 1: _________________________________ |
| Town:____________________
State:___________ Zip Code:___________ |
| E-Mail
Address: _________________________________ |
| Cabin
Category : _________________ (Balcony
or Oceanview) |
| - - - - - - - - -
- - - - - - - - - - - - - - - - - - - - - - -
- - - - - - - - - - - - - - - - - - - - - - -
- - - - - - - - - - - - - - - |
| Name
Passenger # 2:___________________________________________ |
| Date
of Birth: ____/___/____ Home Phone:_______________ |
| Street
Address Passenger # 1: _________________________________ |
| Town:____________________
State:___________ Zip Code:___________ |
| E-Mail
Address: _________________________________ |
| Cabin
Category : _________________ (Balcony
or Oceanview) |
| *
Please indicate your name as it appears on your
Proof of Identification. Supplying me with your
e-mail address will allow me to send invoices
and make changes to your booking more efficiently. |
Make
checks payable to Larry Pashaian Mail to: Larry
Pashaian 30 Varick Ct. Rockville Centre, NY, 11570 |
