Italy Food and Wine Experience Booking Form

Traveler Information

Please ensure the accuracy of your full name, date of birth and gender information. Failure to provide your correct full name, date of birth, and gender may result in denial of transport or denial of authority to enter the boarding area. For more on TSA privacy policies, or to review the system of records notice and the privacy impact assessment, please see the TSA Web site at www.tsa.gov. *Spelling of names, including middle name must exactly match U.S. Passport.

First Name*

First

Middle Name*

Middle

Last Name*

Last

Date of Birth*

Gender*

Mailing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email*

Phone*

Additional Information

Number of Guests (In Your Hotel Room)*

Name of Roommate*

First Last

Roommates must submit their deposit on the same day.

Select your departure city/airport code*

Airfare information will be provided.

Do you currently have a valid U.S. Passport?*

Passport Information

A valid U.S. passport is required to travel to Italy and it must be valid for a minimum of six months after date of arrival to Italy.

Please provide the date you plan to apply for your U.S. Passport*

Passport Information

Passport Number*

Passport Expiration Date*

Passport Issuing Country*

Passport Issuing Date*

Payment Options

How would you prefer to pay for your trip?*

Lump Sum Payment (Full payment at the time of booking)
Non-Refundable Deposit + Basic Payment Plan (no interest) Note: With this option your travel has to be paid in full prior to departure.
12-Month Payment Plan powered by Uplift (low interest and approval required) Note: With this option you can travel now and continue making payments post-travel.

Lump Sum Payment

After you submit your deposit, you will be contacted directly to submit your remaining balance.

Payment Plan Information

Would you like your monthly payment to be withdrawn on the 1st or 15th of each month?*

1st day of each month
15th day of each month

Will you and your roommate be submitting separate payments or will you be on one payment plan?*

Yes, separate payments (each traveler submits their own payment)
No, group payment (only one form of payment)

Please complete the form then click "Submit" button below and we will contact you directly to complete your Uplift™ application. Note: Notiq Agency reduced deposit offers and promotions not available for Uplift™ financing option.

Italy 2020 Additional Information

How did you hear about this getaway?*

For our Michelin Star Dining Experience, please select any dietary restrictions (Select ALL that apply, select None if N/A):*

Note: Your dietary restrictions are only being used for the Michelin Star Dining Experience. This information will not be used for any other meal.

None
Gluten-Free
Dairy-Free
Pescatarian
Vegetarian
Vegan
Other

Other (Please list any other dietary restriction that is not listed)*

Would you like to add the optional day tour to Lucca?*

The cost for this optional tour will be added to your pricing (this optional tour is not included in the itinerary).

Any additional questions or concerns

Secure Payment Information

Note: This card will not be used for any additional payments. You will be contacted directly to complete a credit card authorization form for your remaining balance.

Total Deposit Amount Due

$0.00

Deposit Payment is Non-Refundable

Payment Method*

Credit/Debit Card
Paypal (Submit form and you will be redirected to PayPal for payment)

Billing Address*

Same as previous

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Credit Card*

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name