AL-MADEENA TRAVELS

41-08 55th Street. 2nd Floor. Suite # 201. Woodside. NY 11377

718-619-8595, 646-610-0740

E-Mail: hajj@al-madeena.com   Website: www.al-madeena.com

Hajj 1433/2012 Contract Form

Full Name

(1)............................................................................................................................................

(2) ..........................................................................................................................................

(3)............................................................................................................................................

(4)............................................................................................................................................

(5)............................................................................................................................................

Address:..................................................................................................................................

Tel:............................................................................................................................................

E-Mail:.....................................................................................................................................

JFK-JEDDAH-JFK  Departure date:.................... Return date:.......................

Domestic From: ...........................  Side Trip to:................................ Airport:.....................

   Room:     2      3   4/5 Persons in a room

Payment:  Package                  +  Hajj Draft $295.00 **     +  Qurbani $140.00

                  + Side trip                     Total (per person):                         

                                                                                          Grand Total:...............................

** If you send us money to make hajj draft please add $10.00 processing fee.

Head of the Family: ....................................................Signature..........................................

.........................................................

Representative:..............................................................                Muhammad Ainul Huda

On behalf of Muhammad Ainul Huda                                                                 President

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