EmailMe Form - CLIENT TRAVEL FORM

EmailMeForm

Primary Traveler Name *
Prefix First Last Suffix
Primary Traveler Address: *
City & State *
Zip Code *
Date of Birth *
MM / DD / YYYY
Phone *
### - ### - ####
Email *
Emergency Contact: (Must include First/Last Name, Phone Number, and Email Address) *
Secondary Traveler Name *
Prefix First Last Suffix
Secondary Traveler Address: (If different from Primary):
City & State
Zip Code
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? *
Family Member
Friend
Co-Worker
Promotion/Advertisement
Social Media
Google or Yelp
Travel Leaders Network
**Please specify name of person who referred you in the "Notes Box"**
Select the purpose of your trip
Dates of Travel *
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 *
Destination: *
If "other" destination (Please specify)
Price Range Budget Per Person: *
Will you need AirFare
Will you need Transportation?
Home Airport: *
Do you have bedding preference?
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. *