Florida Express Bus Vacation Package Reservation

The Florida Express Bus Vacation Package Secure Reservation Form
(1) What is your name?	(2) What is your cell phone number?

(3) What is your alternate cell phone number?	(4) What is your e-mail address?

Tell Us About Your Trip!
(5) What is your departure date? (Day of Week / Month / Day / Year)
(6) What time would you like to be picked up?
Please Read: You must be at the station location 20 Minutes Prior to your scheduled pick up time!
(7) How many people will be in the room? Note: Minimum of 2 Reqd.	(8) How many nights are you staying?

(9) What is your return date? (Day of Week / Month / Day / Year)
(10) Select Your Return Trip: Please Read: You must be in the lobby no later than 20 Minutes Prior to your scheduled pick up time!
Tell Us About Your Payment Information!
(11) What type of Credit Card are you using?	(12) What is the name that appears on the Credit Card?

(13) What is the Credit Card Number? (No Spaces or Dashes)	(14) When does it expire?

(15) What is the CVV Code on the back of the card? (Last 3 Numbers)	(16) What is the Billing Zip / Postal Code?

(17) Do you have a Coupon Code? (If No, Leave Blank)	(18) Have you traveled with us before?

When You Click Submit, You Verify That You Agree To The Following: You will be able to print your Confirmation Request and ensure that All information submitted is accurate. Your reservation is not confirmed until your Credit Card is successfully charged. This package is 100% Non-Refundable and No Cancellations will be accepted No Changes Can Be Made Pressing Submit indicates that you have Read, Understood and Agreed to our Terms and Conditions Once you've double checked to ensure that all of the information is accurate and you have Read, Understood and Agreed to the Terms and Conditions, simply Click The Box Below to indicate that you Agree then click Submit My Reservation! You'll be able to print shortly.

(19) (20)