1362 SE 17TH

STREET 8 BLVD D’AGUILLON

FORT LAUDERDALE, FL 33316 WWW.LUXYACHTS.COM ANTIBES, FRANCE 06600

T: +1 (954) 525 9959 T: +33 489 120 970

F: +1 (954) 525 9949 F: +33 497 213 784

CLIENT

Yacht

Charter Date

Board ing / Departure Ports

LYG Agent

FLIGHT INFORMATION Arrival Details Departure Details

Airport / Destination Airport / Destination

Airline Airline

Flight Number Flight Number

Date Date

Time Time

GUEST INFORMATION Please provide the following for each guest

Name Sex Date of Birth Passport Number Country of

Issuance

Shoe Size

(For Fins) Wetsuit Size

1362 SE 17TH

STREET 8 BLVD D’AGUILLON

FORT LAUDERDALE, FL 33316 WWW.LUXYACHTS.COM ANTIBES, FRANCE 06600

T: +1 (954) 525 9959 T: +33 489 120 970

F: +1 (954) 525 9949 F: +33 497 213 784

MEDICAL DETAILS Many or all of your crew members have completed their basic First A id certificates and are able to treat

minor ailments, and administer basic drugs. The crew is also discreet about every guest’s medical condition and uses this information

for planning activities. Please describe any particular medical conditions for any of the guests (such as heart conditions, epilepsy,

diabetes, allergies, etc.).

Name Medical Condition (Please remember to include food allergies!)

SPECIAL OCCASION Would you like the crew to arrange any celebrations during your charter? _____ (i.e.: anniversary,

birthday, holiday, etc.)

The Occasion What date would you like to celebrate this occasion?

1362 SE 17TH

STREET 8 BLVD D’AGUILLON

FORT LAUDERDALE, FL 33316 WWW.LUXYACHTS.COM ANTIBES, FRANCE 06600

T: +1 (954) 525 9959 T: +33 489 120 970

F: +1 (954) 525 9949 F: +33 497 213 784

ITINERARY While we may be able to offer a formal itinerary, the real benefit to chartering your yacht is being able to adapt to

your whims (and the weather!). A lthough not every vessel can provide every activity, please check the activities you would prefer to

participate in.

Activity Check Activity Check

Swimming Wave Runner / Jet Ski

Snorkeling Active cruising, inland excursions/ nightlife (docking at marinas)

SCUBA Diving Relaxing and leaving the world behind (evenings at anchor)

Beachcombing Sailing/ Surfing

Fishing Music/ Dancing

Water Skiing Land Tours/ Shopping

Special Considerations?

Requests?

Will there be any guests on

board that do not swim?

FOOD PREFERENCES To assist the chef in stocking the vessel and planning your menus please make a few notes as to the likes and

dislikes of all members of your party regarding food/beverages. The crew will do their best to provision choices that you have indicated,

however, please remember specific brands may not be available in island locations.

BREAKFAST Circle your preferences or add specifics in blank spaces

Type Like Dislike Your comments/ specifics

Bread ,

Pastry Like Dislike

Breakfast

Meats Like Dislike

Dairy, Eggs

Cheese Like Dislike

Fruit Like Dislike

Other Breakfast Likes

Other Breakfast Dislikes

Special

Requests

1362 SE 17TH

STREET 8 BLVD D’AGUILLON

FORT LAUDERDALE, FL 33316 WWW.LUXYACHTS.COM ANTIBES, FRANCE 06600

T: +1 (954) 525 9959 T: +33 489 120 970

F: +1 (954) 525 9949 F: +33 497 213 784

LUNCH & DNNER Circle your preferences or add specifics in blank spaces and circle

Cuisine Like Dislike Your comments/ specifics

Asian Like Dislike

Spicy Like Dislike

Italian Like Dislike

French Like Dislike

American Like Dislike

Mexican Like Dislike

Other Cuisine Type Likes

Other Cuisine Type Dislikes

Other

Special

Requests

Food Types Like Dislike Your comments/ specifics

Beef Like Dislike

Chicken Like Dislike

Lamb Like Dislike

Pork Like Dislike

Quail

Pigeon Like Dislike

Veal Like Dislike

Venison

Ostrich Like Dislike

Fish Like Dislike

Shellfish Like Dislike

1362 SE 17TH

STREET 8 BLVD D’AGUILLON

FORT LAUDERDALE, FL 33316 WWW.LUXYACHTS.COM ANTIBES, FRANCE 06600

T: +1 (954) 525 9959 T: +33 489 120 970

F: +1 (954) 525 9949 F: +33 497 213 784

Food Types Like Dislike Your comments/ specifics

Salad s Like Dislike

Vegetables Like Dislike

Hors

D’oevres Like Dislike

Caviar

Foie Gras Like Dislike

Canapés Like Dislike

Desserts Like Dislike

Other Cuisine Type Likes

Other Cuisine Type Dislikes

Other

Special

Requests

BEVERAGE PREFERENCES If the rate is “inclusive” the “bar” may include: beer, table wine, soft drinks with basic and standard

brands. Inclusive rates do not provide for specialty foods, fine spirits or vintage wines or champagne. Such items can be purchased at

your own expense. As we try to accommodate all preferences please note that not all specific brands are available in ALL locations.

SOFT DRINKS, JUICES, MIXERS & WATER

Drink Types Like Dislike Specific Brand s (If Any)Also specify Diet/ Gas / No Gas / Fresh Squeezed/ etc. Quantity

(Bottles)

Quantity

(Cases)

Cola Like Dislike

Lemon

Lime Soda Like Dislike

Ginger Ale Like Dislike

Club Soda Like Dislike

Tonic

Water Like Dislike

Fruit Juice Like Dislike

1362 SE 17TH

STREET 8 BLVD D’AGUILLON

FORT LAUDERDALE, FL 33316 WWW.LUXYACHTS.COM ANTIBES, FRANCE 06600

T: +1 (954) 525 9959 T: +33 489 120 970

F: +1 (954) 525 9949 F: +33 497 213 784

Drink Types Like Dislike Specific Brand s (If Any)Also specify Diet/ Gas / No Gas / Fresh Squeezed/ etc. Quantity

(Bottles)

Quantity

(Cases)

Water Like Dislike

Lemonade Like Dislike

Ice Tea Like Dislike

Coffee Like Dislike

Tea Like Dislike

Hot Choc Like Dislike

Other Drink Likes

Other Drink Dislikes

Other

Special

Requests

ALCOHOL

Drink Types Like Dislike Specific Brand s (If Any) Quantity

(Bottles)

Quantity

(Cases)

Beer Like Dislike

Scotch Like Dislike

Bourbon Like Dislike

Whiskey Like Dislike

Gin Like Dislike

Vodka Like Dislike

Rum Like Dislike

Apertifs Like Dislike

Digestifs Like Dislike

1362 SE 17TH

STREET 8 BLVD D’AGUILLON

FORT LAUDERDALE, FL 33316 WWW.LUXYACHTS.COM ANTIBES, FRANCE 06600

T: +1 (954) 525 9959 T: +33 489 120 970

F: +1 (954) 525 9949 F: +33 497 213 784

Drink Types Like Dislike Specific Brands (If Any) Quantity

(Bottles)

Quantity

(Cases)

Liquors Like Dislike

Cocktails Like Dislike

Other Drink Likes

Other Drink Dislikes

Other

Special

Requests

WINE Some vessels provide their own wine list, which may be furnished in advance upon request -or- list your favorite wines and

every effort will be made to obtain them. We can further supply a wine list from a local company that supplies French and

International wines and beverages.

Wine Types Like Dislike Label or Type (List if you have a preference)

Approx

Cost per

Bottle

Number

Of Bottles

Red Like Dislike

White Like Dislike

Rose Like Dislike

Champagne Like Dislike

Other Wine Likes

Other Wine Dislikes

Other

Special

Requests