Costa Agency Form

Reservation of Costa Cruises from here title icon

You can make a reservation on this form.

Please complete the information below and send it to us.

After entering this form, your representative will contact you.

Applicant Information

Name of Applicant

※Required

(Salutation)

(First Name)

(Last Name)

※ Please write in the same notation as your name on your passport.

Applicant Address

※Required

Gender

※Required

Male Female

Date of Birth

※Required

※ In the case of January 1, 1980 → please enter 19800101

Email Address

※Required

Contact Details

※Required

Desired Cruise

Departure Date

※Required

year month day

Ship Name

※Required

Departure City

Cabin Type

※Required

No. of passengers per cabin

※Required

Person

※ Please enter the number of persons + companions included

Accompanying person information

※ Please fill in the companion information, excluding the applicant.

※ Please include children aged 0 to 13 in the number of users.

※ A maximum of 3 companions can apply.

Accompanying person1

Name of Applicant

※Required

(Salutation)

(First Name)

(Last Name)

※ Please write in the same notation as your name on your passport.

Gender

※Required

Male Female

Date of Birth

※Required

※ In the case of January 1, 1980 → please enter 19800101

Accompanying person2

Name of Applicant

※Required

(Salutation)

(First Name)

(Last Name)

※ Please write in the same notation as your name on your passport.

Gender

※Required

Male Female

Date of Birth

※Required

※ In the case of January 1, 1980 → please enter 19800101

Accompanying person3

Name of Applicant

※Required

(Salutation)

(First Name)

(Last Name)

※ Please write in the same notation as your name on your passport.

Gender

※Required

Male Female

Date of Birth

※Required

※ In the case of January 1, 1980 → please enter 19800101

About withdrawal of personal information

Your personal information provided is strictly managed based on our privacy policy .
And, we will use it for the notification about the reservation and the guide of the service.

I agree to the above rules