Contact Information

Name:

_____________________________________________

E-mail Address:

_____________________________________________
Example: yourname@abc.com

Daytime Phone:

_____________________________________________
The name of your client contact for this trip

Address:

_____________________________________________

_____________________________________________

General

Number of Travelers:

_____________________________________________

_____________________________________________
Full names, as they appear on passports, for all travelers

Departing City:

_____________________________________________

Need to book airfare?     ___Yes ___No

Departure Date:

_____________________________________________
This date can be approximate.

Return Date:

_____________________________________________
This date can be approximate.

Destinations

Destinations:

_____________________________________________

Has traveled internationally before?     ___Yes ___No

Has traveled to the destination(s) before?    ___Yes ___No

Services

Accommodations:

[  ] Moderate  [  ] Deluxe  [  ] Luxury 

Transportation:

[  ] Rail  [  ] Car Rental  [  ] Car & Driver 

[  ] Motor Coach Tour 

Sightseeing / Tours:

[  ] Self Guided   [  ] Private Guide  [  ]Group Tour 

[  ] Half Day  [  ]  Full Day 

Special Requirements:

_____________________________________________

_____________________________________________
Example: dietary, wheel chair access, non-smoking, etc...

Budget

Budget Guidelines:

_____________________________________________
Total trip cost per person

Budget Includes:

[  ] Hotel  [  ] Meals  [  ] Air  [  ] Car  [  ] Rail  [  ] Transfers 
[  ] Private Guide  [  ] Group Tours 

Activities

Travel Pace:

___ Leisurely ___ Moderate ___ Fast Paced

Physical Activities:

_____________________________________________
For example; trekking, wildlife viewing, skiing, golf, sailing, etc

Cultural Activities:

_____________________________________________
For example; local culture, art, history, cooking classes, etc

Children's Interests:

_____________________________________________
If traveling with children, their interests and ages