EmailMe Form - QUALIFYING CLIENT FORM

EmailMeForm

#1: PRIMARY TRAVELER *
First Middle Last
Name as it appears on your government ID
Do you have a passport? *
Yes
No
Date of Birth *
MM / DD / YYYY
Wedding Anniversary Date: *
MM / DD / YYYY
Are you a veteran of the U.S. Military? *
Yes
No
Email *
Phone *
### - ### - ####
Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Home Airport choices: *

AIRPT #1:

AIRPT #2:

AIRPT #3:
Traveler #1 - Airline Seat Preference: *
Window
Middle
Isle
This is for the Primary traveler placement; all other travelers will be placed accordingly.
Disabilities:
Please include any disabilities or limitations here. (For example, I have a bad knee keep me on the lower floors)
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
Traveling Companion(s):
#2: Name as it appears on your government ID
First MI Last
Do you have a passport?
Yes
No
Date of Birth
MM / DD / YYYY
Gender
Male
Female
Transgender
Are you a veteran of the U.S. Military?
Yes
No
Relationship
Email
Phone
### - ### - ####
Home Airport choices (Only if different than Primary Traveler #1):

AIRPT #1:

AIRPT #2:

AIRPT #3:

(Only if different than Primary Traveler #1)
Traveler #2 - Airline Seat Preference:
Window
Middle
Isle
ADD Rewards/Miles Numbers Here:

Company Rewards #:

AIRFARE

HOTEL

CAR
Disabilities:
Please include any disabilities or limitations here. (For example, I have a bad knee keep me on the lower floors)
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
DESTINATION DETAILS * * * DESTINATION DETAILS
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
TRAVEL PREFERENCE: *
PACKAGE (airfare, hotel & transportation)
Hotel & Car Rental
Hotel Only
Car Rental Only
Excursions Only
BUDGET RANGE ($$ - $$$$) *

Minimum $ Amount Maximum $ Amount

What is your Budget Range ($$) - (per person):
Destination (where are you looking to go?): *
Special Occasion:
Are you celebrating something special during this trip?
* * * * * * * * TRAVEL DATES AND TIMES * * * * * * * *
Travel Time frame FROM: *
MM / DD / YYYY
Travel Time frame TO: *
MM / DD / YYYY
Travel Preference FROM: *
Morning
Afternoon
Evening
Travel Preference TO: *
Morning
Afternoon
Evening
HOTEL:
Hotel Brand Preference:
Do you have a hotel preference?
Ideas of Amazing Fun Tours and/or Activities:
List any tours and/or activities on your bucket list.
Special Needs:
Please list any special needs requirements.
TRAIN:
Train rides? *
Yes
No
Train ride(s) details:
Please list/describe any train ride details/destinations.
RENTAL CAR:
Rental Car? *
Yes
No
Car Preference:
Economy
Midsize
Minivan
SUV
Luxury ($$$)
TRAVEL PROTECTION:
Are you interested in travel protection insurance? *
YES, Basic ($)
YES, Cancel at Anytime ($$)
Decline
While travel insurance is not required, we highly recommend that you purchase a comprehensive travel insurance policy prior to departure to protect your travel purchases. If you do purchase travel insurance, please review your policy carefully for specific terms and conditions" and a waiver will need to be completed.
(if no other travelers skip to the end)

Any Additional TRAVELERS?:
3. Name
First Last
Date of Birth
MM / DD / YYYY
Do you have a passport?
Yes
No
Gender
Male
Female
Transgender
Relationship
Seat Choice:
Window
Middle
Isle
This is for the Primary traveler placement; all other travelers will be placed accordingly.
Home Airport choices (Only if different than Primary Traveler #1)

AIRPT #1:

AIRPT #2:

AIRPT #3:
ADD Rewards/Miles Numbers Here:

Company Rewards #:

AIRFARE

HOTEL

CAR
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4. Name
First Last
Do you have a passport?
Yes
No
Date of Birth
MM / DD / YYYY
Gender
Male
Female
Transgender
Relationship
Seat Choice:
Window
Middle
Isle
This is for the Primary traveler placement; all other travelers will be placed accordingly.
Home Airport choices (Only if different than Primary Traveler #1):

AIRPT #1:

AIRPT #2:

AIRPT #3:
ADD Rewards/Miles Numbers Here:

Company Rewards #:

AIRFARE

HOTEL

CAR
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5. Name
First Last
Do you have a passport?
Yes
No
Date of Birth
MM / DD / YYYY
Gender
Male
Female
Transgender
Relationship
Seat Choice:
Window
Middle
Isle
This is for the Primary traveler placement; all other travelers will be placed accordingly.
Home Airport choices (Only if different than Primary Traveler #1):

AIRPT #1:

AIRPT #2:

AIRPT #3:
ADD Rewards/Miles Numbers Here:

Company Rewards #:

AIRFARE

HOTEL

CAR
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6. Name
First Last
Do you have a passport?
Yes
No
Date of Birth
MM / DD / YYYY
Gender
Male
Female
Transgender
Relationship
Seat Choice:
Window
Middle
Isle
This is for the Primary traveler placement; all other travelers will be placed accordingly.
Home Airport choices (Only if different than Primary Traveler #1):

AIRPT #1:

AIRPT #2:

AIRPT #3:
ADD Rewards/Miles Numbers Here:

Company Rewards #:

AIRFARE

HOTEL

CAR
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

	Minimum $ Amount	Maximum $ Amount
What is your Budget Range ($$) - (per person):

AIRPT #1:
AIRPT #2:
AIRPT #3:

AIRPT #1:
AIRPT #2:
AIRPT #3:

	Company	Rewards #:
AIRFARE
HOTEL
CAR

AIRPT #1:
AIRPT #2:
AIRPT #3:

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Traveling Companion(s):

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * DESTINATION DETAILS * * * DESTINATION DETAILS * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

* * * * * * * * TRAVEL DATES AND TIMES * * * * * * * *

HOTEL:

TRAIN:

RENTAL CAR:

TRAVEL PROTECTION:

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* * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
Traveling Companion(s):

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
DESTINATION DETAILS * * * DESTINATION DETAILS
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *