Japan Rail Pass Order Form
- Requires a minimum of five (5) business days to process your Japan Rail Pass when booking online.
  Please contact one of our branch offices for immediate assistance. Delivery limited to the U.S. addresses only.
JR PASS Type:
Adult:
Child:
How many?:
How many?:
Departure Date*:
H.I.S. Los Angeles Calendar
* Please indicate your expected departure date from the U.S.A.
DeliveryMethod*:
At office:Free
Please indicate which office you would like to pick up the pass(es).
(H.I.S. Locations)

Please indicate when you would like to pick up the pass(es)
H.I.S. Los Angeles Calendar

 
Delivery Charge: $10 - Shipping Rates for Hawaii & Alaska may vary
Please indicate your delivery address: (Limited to the U.S. only)
(Street)
(City) (State) (Zip)
Primary Traveler  
Name*:
Prefix: First Name: Last Name:
E-mail**:
Phone (Home):
Phone (Day Time)***:
* Please enter your name as it appears on your passport. (Middle Name is not necessary)
** Please enter a valid e-mail address. We do not accept order without a valid e-mail address.
*** Please enter your Day Time Phone Number where we can reach you.
Travel Companion 1 Travel Companion 2
Prefix: Prefix:
First Name: First Name:
Last Name: Last Name:
Age (child): Age (child):
Please enter your companion's name as it appears on passport.
(Middle Name is not necessary)

Child (Ages 6 - 11)
Please enter your companion's name as it appears on passport.
(Middle Name is not necessary)

Child (Ages 6 - 11)
Travel Companion 3 Travel Companion 4
Prefix: Prefix:
First Name: First Name:
Last Name: Last Name:
Age (child): Age (child):
Please enter your companion's name as it appears on passport.
(Middle Name is not necessary)

Child (Ages 6 - 11)
Please enter your companion's name as it appears on passport.
(Middle Name is not necessary)

Child (Ages 6 - 11)
 
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CST#:2017288-40