First Name              Last Name

      Address

            City    State    Zip

     Country

  Phone(days)   Phone(eve)    Fax

  When is the best time to call you? morning afternoon evening

  E-mail 

  Is this form being completed with the intent of making a reservation?yes no

  How soon are you planning on making a decision? As soon as possible! In less than 1 month In less than 3 months In 3 to 6 months I'm just shopping right now

  When do you want to cruise? 

  Where do you want to cruise? (please be as specific as possible):

  How long do you want to cruise? 2-3 days 4-5 days 7 days 10+ days Other     

                  How many adults? 1 2 3 4 other  

       Seniors Ages (if applicable): 

                 How many children? 0 1 2 3 4 other  

     Children's ages (if applicable):

  How many cabins do you want? 1 2 3 4 other Cabin preference Inside Oceanview Balcony Suite Other

  Will you need round-trip air? yes no

  If so, from what city?

  How much do you want to spend per person? not sure $500 $500-$1000 $1001-$1500 $1501-$2500 $2501-$3500 $3501-$4500 $4500+

  Are you a past passenger of Cruise Brokers International? not sure yes no

  Have you cruised before? not sure yes no

  Do you have a preference in a cruise line?

  Do you have a preference in a cruise ship?

  Are you a past passenger of this cruise line? yes no

  Where did you hear about us?  

  If on the net, through search engine or another website?

  Comments: Insert any special requests not covered on this form.  If you are

  shopping purely for the best price, indicate in this section the best price that

  you have been quoted.