Empire Travel Booking Registration Form

Thank you for trusting Empire Travel with your booking! Please NOTE This form does NOT confirm your travel, we will take this information and send you a separate confirmation once booked.

Kindly ensure that the names you are providing for yourself are the legal names as per your passports. Please note that misspelled or incorrect names could cause denial of boarding. Any changes made after the booking has been confirmed by this form will be subject to a change fee as per Terms & Conditions found here: https://www.empiretravel.ca/covid19

Title *

Passenger 1: First Name *

Middle Name (if applicable)

Last Name *

Date of Birth (d/mm//yyyy) *

Age at time of travel *

Passenger 2 (if applicable)

Title

Passenger 2: First Name

Middle Name (if applicable)

Last Name

Date of Birth (d/mm//yyyy)

Age at time of travel

Passenger 3 (if applicable)

Title

Passenger 3: First Name

Middle Name (if applicable)

Last Name

Date of Birth (d/mm//yyyy)

Age at time of travel

Passenger 4 (if applicable)

Title

Passenger 4: First Name

Middle Name (if applicable)

Last Name

Date of Birth (d/mm//yyyy)

Age at time of travel

Billing Address for Primary Passenger

Phone Number *

Email Address *

Street Address *

City *

State/Province/Region *

Zip/Postal Code *

Please submit your credit card info below

Name on Card

Credit Card Type

Amount to charge (deposit or final)

Credit Card Number

Security Code 🛈

Expiry Date

Empire Travel strongly recommends the purchase of Travel Insurance. Would you like a quote on Travel Insurance?

Your booking is 100% non refundable and no changes permitted after booking *

We've already discussed, please ADD ON the insurance Empire Travel quoted me

Send me a quote for the All-Inclusive Package (Most inclusive: Includes Trip Cancellation, Interruption, and Medical, as well as Baggage loss or delay, travel accident, etc.)

Send me a quote Non Medical Package (Includes Cancellation & Interruption, but NO Medical coverage)

I'm not sure could you call me to discuss further?

I am DECLINING all travel insurance and will not hold EMPIRE TRAVEL responsible for any potential losses that may occur

I have confirmed that the names above match the passports *

YES

NO

Issuing Country of Passport: Issuing Country of Passport:

I have confirmed my passport has a validity date of 6 months after my date of return for travel. *

YES

NO

Issuing Country of Passport: Issuing Country of Passport:

Please read our full TERMS & CONDITIONS as found on https://www.empiretravel.ca/covid19 as well as your individual supplier terms & conditions which can be found on the suppliers individual websites or here: https://www.empiretravel.ca/supplierterms If you would like guidance on where to find the link for those please reach out to us prior to signing. By signing BELOW you accept the terms and conditions of Empire Travel, TPI and the Supplier Partner of which the booking is made and allow Empire Travel, TPI to charge your credit card for travel as discussed. Empire Travel, TPI or our agents will not be held accountable for anything that is stated in the Terms & Conditions. *

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Comments or Requests: