Walt Disney World Quote Request Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone*Email* Your Travel DatesAre your dates flexible? If yes, enter date rangeArrival Date Date Format: MM slash DD slash YYYY Departure Date Date Format: MM slash DD slash YYYY Your Travel PartyHow many adults in your party (ages 18 and up)?:How Many Children in your party?What are the ages of the children?:Walt Disney World Resort AccommodationsDisney Resort HotelHow many rooms?Do you want to add the dining plan?YesNoAdditional features for your tickets (select all that apply) Park Hopper Water Park Fun & More Additional Information:Select an AgentAny AgentAlex MurphyAlicia von KugelgenAmanda WhiteAmy CarverAnna PretkoAvi BaechtBob AngeloBrenda KenworthyBrittany PerkinsCarie HammCheryl DoyleChris SharpsChristy DudleyCorinne TriggCourtney GiddingsCris BravoDamen TomassiDawn SethmanDayna RiceDebbie MatulloDebbie NebelDennis KempDiana SimpsonDonna DeGiacomoEmily MooreGinger HensonJamie McCarthyJarrett FennemaJenni BorskiJennifer WebsterJenniferMarie HughesJeremy SchmitzJessica CorreiaJohn BarbianJordan CurcioJorge CortésJulianne MarmolJulie DaviesKelly BiasKelsey NewberryKendra CrameKim ThommesKourtney KantorKristen HugginsKristen MakinsKristi SchwabKristi NoyesKristi HardawayKristin ZarchanKristyn HabickLauren MasarikLee TaylorLesli TerzoLisa MollitorLynne Marie PisanoMary HalesMarybeth RubinacciMaryIrene CorriganMatt TurnerMatt CarreraMegan GrangerMeghan LozanoMeghan SgambatiMichael ManiaciMichele DakhoMichelle SeitherMike EllisMindy MeagorMisty FlippoMonica StrohmMonica EnglehartNicole CaywoodNicole RaglandNina PatelPatty GilesRob BurtRobert BucherSam HedgesShawn JanofskiSherry MassenburgStacey FrostStefanie GladfelterStephanie SeveranceStephanie WernerStephanie LorenzoTabitha WoodardTammy FranklinTed DavisTiffany DehnTracey RobbinsVanessa SeigerThis is my first request with Pixie Vacations:YesNoTravel Insurance. Include in this quote?YesNoWould you like us to HOLD a reservation for you while you look it over? Rooms and specials at Disney World book quickly. We can put a complementary hold on your reservation for seven days while you review the quote. To do a hold, we need your phone number and everyone's first and last name in the party. You can enter everyone's names in the Notes field at the bottom of the form. No credit card is needed and you are not committed. If you do not book within 3 days the reservation simply goes away.What Website, Friend, Story, can we thank for telling you about us?NotesPlease indicate any additional information so we can be sure to plan the Walt Disney World vacation that is just right for you. If you would like air quoted in your Disney Vacation, please add your airport code. When you submit this form we will contact you with pricing. Rates and specials are subject to change prior to booking your reservation by making a deposit.I have read and agree to these Terms of Service. I understand these terms and conditions and cancellation policies set by the Walt Disney Travel Company & the Walt Disney Company
