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Motorcoach Tour Reservation Form PO Box 368 Old Town, ME 04468 Name: Phone: Street: City: State: Zip: Tour Name: Tour Date: Email: Departure Location: Please consult individual itineraries for departure locations. I/WE PREFER SPECIAL NEEDS Single Double – Dbl/Queen Wheelchair accessible 1 Bed – 1 Person 2 Beds – 2 People motorcoach Non-Smoking Double – Dbl/Queen Triple/Quad – Dbl/Queen Walking challenged 1 Bed – 2 People 2 Beds – 3 or 4 People Smoking Handicap room First floor rooming accommodations (For health reasons, only if elevators are not available) PAYING BY CHECK Check Enclosed Deposit Full Payment Please make checks payable to Cyr Northstar Tours. REMEMBER to send a SEPARATE CHECK For each trip Meal Choice(s): Special Requests: PAYMENT INFO PAYING BY CREDIT CARD Charge to my: VISA MasterCard Discover Amex *Reminder: If booking 60 days or more prior to tour departure please submit the discounted rate (5% off rate). Amount Debited to card $ Deposit Full Payment Card Number: Exp. Date: CVV: Name on Card: Signature: If you have friends traveling with you, please include their names and addresses below. Traveling with Roommate Name Address City/State/Zip Phone Number Traveling with Roommate Address City/State/ Name Zip Phone Number Adjoining Room - With Who: ROOMMATE/TRAVELING PARTNERS Mail completed form and payment to: Cyr Northstar Tours • PO Box 368 • Old Town, ME 04468


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