AIR TICKETING RESERVATION FORM

Personal Details: ( Note: All fields denoted with an asterisk are mandatory. )
IMPORTANT!! Please furnish all the details. Fields marked with " * " is compulsory. Names furnished here will be the names used to book the tickets. We require one name per ticket. Pls re-submit if more than 3 tickets are required.

Name of Adult ( Title, Firstname, Lastname )
1 *
2
3
Children: ( 2 - 12 years old ) ( Title, Firstname, Lastname, Date of Birth)
NOTE: Mstr - male child 2-12 years old; Mist - female child 2-12 years old
1 /
2 /
Infants: ( below 2 years old ) ( Firstname, Lastname, Date of Birth )
1 /
2 /
Note: Please furnish complete e-mail address so that our reply could reach you.
E-mail Address *
Alternative E-mail Address
Optional
Home Phone Number
 *
Business Phone Number
Optional
Mobile Phone Number
Optional
Fax Number
Optional
Country of Residing
Nationality *
Company Name ( if applicable )
Correspondence Address *
Reservation Details
Departure Airport *
Arrival Airport *
Preferred Airline
Class Of Journey
(First / Business / Economy)
Date of Travel *
Return Date Of Travel (if applicable)  
Payment Details ( Note: A credit card payment form shall be sent to you thru e-mail in reply to the above reservation. )
By Credit Card
By Bank Transfer ( US Dollars Only )
Delivery Option ( Note: Please indicate how you would like to have the ticket (s) delivered.Kindly chose one from the four options. )
Courier Service Send by courier. Please furnish your address and add another fee for courier charge.
Deliver to Hotel If you are staying in Hotel ( give the details)
Send PTA Ticket Please furnish us your complete address, Tel # & fax #
Others ( Please furnish us the complete details of your preferred mode of delivery
(not stated above) and we will do our very best to comply accordingly. )
Do you need Hotel Reservations: Do you need Airport Transfer

Please indicate your budget per room per night.

Type name of the Hotel Preference in any:

BreezeIndia Holidays At your service always!!

We will respond to you within 24 hours about the cost, availability, and an option date of your inquiry/reservation.

If you encounter any returned e-mail OR difficulties sending your booking details through this form, you may send your booking details to our help desk at our main reservation office at e-mail address
travel@breezeindiaholidays.com