EmailMe Form - CLIENT TRAVEL FORM

Name *

Prefix First Last Suffix

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Date of Birth *

MM / DD / YYYY

Phone *

### - ### - ####

Email *

Emergency Contact: (Must include First/Last Name, Phone Number, and Email Address) *

Name

Prefix First Last Suffix

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Date of Birth

MM / DD / YYYY

Phone

### - ### - ####

Email

Emergency Contact: (Must include First/Last Name, Phone Number, and Email Address)

How did you hear about us? *

Select the purpose of your trip

Dates of Travel *

If cruising., how many nights sail?

4-5 Nights

7 Nights

10+ Nights

How many Adults *

How many Children?

Name (as it appears on passport):

Birth date and age of all travelers:

YOU MUST PROVIDE A COPY OF YOUR PASSPORT upon completion of International Bookings *

Upload Copy of Passport

Destination: *

If "other" destination (Please specify)

Are you fully vaccinated for the COVID-19 virus? *

Is other traveling passenger fully vaccinated for the COVID-19 virus?

Price Range Budget Per Person: *

Will you need AirFare

Will you need Transportation?

Home Airport: *

Do you have bedding preference?

If you are traveling internationally, you must provide a copy of your Passport. Please type your name below that you acknowledge *

Would you like Travelers Insurance?
(Highly Recommended) *

Would you like Excursions/Activities? (If Yes, Specify)

NOTES BOX

IMPORTANT:

Please be aware that once you have made the decision to hire our agency as your personal travel agent; there will be a one time planning fee of $125.00 for individual bookings that will be assessed. This payment is due before we start the booking process. Instructions will be given on how to make that payment.

We appreciate your business and we look forward to helping you create the perfect vacation. Please initial below if you agree. *