INQUIRY FORM
This service is for customers with hearing and speech disabilities.
We will not reply to any other inquiries made through this form.
Thank you for choosing Peach. Use BLOCK LETTERS when you completing this form. Please submit the Portable Oxygen
Concentrator (POC) Check Form by document submission form or fax at least 3 days before departure.
・Files Submission Form: https://support.flypeach.com/hc/en-us/articles/360006510914
・FAX:+81-50-3737-9665
・Live chatting:https://support.flypeach.com/hc/en-us/categories/115000263233

Please note the following when using this form
* operating hours 9:00 - 18:00 (JST)* If you would like to make a new reservation, change or cancel your reservation, please use the dedicatedform for each.

Date of Submission
１．Contact Information
Name
E-mailFAX Number
２．Requests/Comments

３．Reservation Details (if any)
Booking number:＜Passenger Name＞①②③＜Itinerary＞
Date

Travel Segment (DEP-ARR)

Flight No.

／→MM／→MM* Please DO NOT include credit card information on this form. We may confirm this by phone after
reviewing your request.
* Flight availability, fare, fees and charges are applied on date of fax receipt.

CC-021-017© Peach Aviation Limited – 2021 All rights reserved

INQUIRY FORM (new booking)This service is for customers with hearing and speech disabilities.
We will not reply to any other inquiries made through this form.
Thank you for choosing Peach. Use BLOCK LETTERS when you completing this form. Please submit the Portable Oxygen
Concentrator (POC) Check Form by document submission form or fax at least 3 days before departure.
・Files Submission Form: https://support.flypeach.com/hc/en-us/articles/360006510914・FAX:+81-50-3737-9665
・Live chatting:https://support.flypeach.com/hc/en-us/categories/115000263233

If you want to make a booking, please note the following:* operating hours 9:00 - 18:00 (JST)* Fares and fees will be applied based on the date fax is received.
* Only Credit Card and Peach Points are accepted as form of payment.
Due to security reasons, we may confirm this by phone after receiving your request.
（A substitute is allowable to speak on behalf of contact person below if needed.）* Convenience store and ATM payments are only available for booking made via our website.

１．Contact Information (which we reply to)
NameE-mail
FAX Number

２．Payment *Please choose and circle the method
Credit Card/

Peach Point* Please DO NOT include credit card information on this form.
* VISA, MasterCard, JCB and Diners Club are accepted for Japanese Yen payments
VISA, MasterCard and JCB are accepted for payments in other currencies.

３．Itinerary
Date (MM/DD)

Travel Segment (DEP-ARR)

Flight No

Departure Time／→

MM:／→

MM:／→

MM:／→

MM:

CC-021-018© Peach Aviation Limited – 2021 All rights reserved

４．Passenger Information
Family name*Name should be same as your passport
First nameTitle

Passport Information （for overseas travel）

Date of birth（YYYY/MM/DD）

Passport Number

Issuing country

Nationality

Expiry date（YYYY/MM/DD）

①
②
③
④
⑤
⑥

Name of contact person:

Contact email:Contact Phone number (substitute person allowable)* We will send itinerary to the contact person. Please include a valid email address that can receive emails from Peach “@resmail.flypeach.com”

５．Message
If you want to request fare type and seat selection, please list below.

CC-021-019© Peach Aviation Limited – 2021 All rights reserved

INQUIRY FORM (change booking)This service is for customers with hearing and speech disabilities.
We will not reply to any other inquiries made through this form.
Thank you for choosing Peach. Use BLOCK LETTERS when you completing this form. Please submit the Portable Oxygen
Concentrator (POC) Check Form by document submission form or fax at least 3 days before departure.
・Files Submission Form: https://support.flypeach.com/hc/en-us/articles/360006510914
・FAX:+81-50-3737-9665
・Live chatting:https://support.flypeach.com/hc/en-us/categories/115000263233

If you want to make a booking, please note the following:* operating hours 9:00 - 18:00 (JST)* Fares and fees will be applied based on the date fax is received.
* Only Credit Card and Peach Points are accepted as form of payment.
Due to security reasons, we may confirm this by phone after receiving your request.
（A substitute is allowable to speak on behalf of contact person below if needed.）

１．Contact Information (which we reply to)
NameE-mailFAX Number
２．Payment *Please choose and circle the method
Credit Card/

Peach Point* Please DO NOT include credit card information on this form.
* VISA, MasterCard, JCB and Diners Club are accepted for Japanese Yen payments.
VISA, MasterCard and JCB are accepted for payments in other currencies）

３．Reservation Details
Booking number<Contact information when booking>
Name of contact person:

Contact email:<Passenger Information>①②③

CC-021-020© Peach Aviation Limited – 2021 All rights reserved

<Itinerary>
Please choose and circle

New departure date (DD/MM)

New Flight number*If you change*If you change①

Change / NOT change

／

MM

②

Change / NOT change／MM③

Change / NOT change／

MM４．Message
If you want to change booking for one of the member or change options, please list below.

CC-021-021© Peach Aviation Limited – 2021 All rights reserved

INQUIRY FORM (cancel booking)This service is for customers with hearing and speech disabilities.
We will not reply to any other inquiries made through this form.
Thank you for choosing Peach. Use BLOCK LETTERS when you completing this form. Please submit the Portable OxygenConcentrator (POC) Check Form by document submission form or fax at least 3 days before departure.
・Files Submission Form: https://support.flypeach.com/hc/en-us/articles/360006510914
・FAX:+81-50-3737-9665
・Live chatting:https://support.flypeach.com/hc/en-us/categories/115000263233

If you want to make a booking, please note the following:* operating hours 9:00 - 18:00 (JST)* Some fares are non-refundable, so please check the fare rules on our website in advance.
１．Contact Information (which we reply to)
NameE-mailFAX Number
２．Reservation Details
Booking number<Contact information when booking＞>
Name of contact person:

Contact email:<Passenger Information>④⑤⑥<Passenger Information>
Please choose and circle

Cancel departure date (DD/MM)

Cancel Flight number*If you cancel*If you cancel①

Cancel / NOT cancel

／

MM

②

Cancel / NOT cancel

／

MM

③

Cancel / NOT cancel／

MM

３．Message

CC-021-022© Peach Aviation Limited – 2021 All rights reserved