EmailMeForm
Pre-Client Qualifier
Let's get the planning started....
Please complete the below form.
Today's Date
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MM
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DD
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YYYY
Name as it appear on your government ID
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First
Last
Your Birth date:
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MM
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DD
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YYYY
Address
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Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Aruba
Bahamas
Barbados
Belize
Canada
Cayman Islands
Cook Islands
Costa Rica
Cuba
Dominica
Dominican Republic
El Salvador
Grenada
Guatemala
Haiti
Honduras
Jamaica
Mexico
Netherlands Antilles
Nicaragua
Panama
Puerto Rico
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Trinidad and Tobago
United States
Argentina
Bolivia
Brazil
Chile
Colombia
Ecuador
Guyana
Paraguay
Peru
Suriname
Uruguay
Venezuela
Albania
Andorra
Armenia
Austria
Azerbaijan
Belarus
Belgium
Bosnia and Herzegovina
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Faroe Islands
Finland
France
Georgia
Germany
Greece
Hungary
Iceland
Ireland
Italy
Kosovo
Latvia
Liechtenstein
Lithuania
Luxembourg
Macedonia
Malta
Moldova
Monaco
Montenegro
Netherlands
Norway
Poland
Portugal
Romania
San Marino
Serbia
Slovakia
Slovenia
Spain
Sweden
Switzerland
Ukraine
United Kingdom
Vatican City
Afghanistan
Bahrain
Bangladesh
Bhutan
Brunei Darussalam
Myanmar
Cambodia
China
East Timor
Hong Kong
India
Indonesia
Iran
Iraq
Israel
Japan
Jordan
Kazakhstan
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Lebanon
Malaysia
Maldives
Mongolia
Nepal
Oman
Pakistan
Palestine
Philippines
Qatar
Russia
Saudi Arabia
Singapore
Sri Lanka
Syria
Taiwan
Tajikistan
Thailand
Turkey
Turkmenistan
United Arab Emirates
Uzbekistan
Vietnam
Yemen
Australia
Fiji
Kiribati
Marshall Islands
Micronesia
Nauru
New Zealand
Palau
Papua New Guinea
Samoa
Solomon Islands
Tonga
Tuvalu
Vanuatu
Algeria
Angola
Benin
Botswana
Burkina Faso
Burundi
Cameroon
Cape Verde
Central African Republic
Chad
Comoros
Democratic Republic of the Congo
Republic of the Congo
Djibouti
Egypt
Equatorial Guinea
Eritrea
Ethiopia
Gabon
Gambia
Ghana
Gibraltar
Guinea
Guinea-Bissau
Cote d'Ivoire
Kenya
Lesotho
Liberia
Libya
Madagascar
Malawi
Mali
Mauritania
Mauritius
Morocco
Mozambique
Namibia
Niger
Nigeria
Rwanda
Sao Tome and Principe
Senegal
Seychelles
Sierra Leone
Somalia
South Africa
Sudan
Swaziland
United Republic of Tanzania
Togo
Tunisia
Uganda
Zambia
Zimbabwe
Country / Region
Phone
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Email
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Do you have a passport?
Yes
No
List all hobbies, leisure activities, and professional and social affiliations:
(I am a member of the local art guild” or “I love wine to go to wineries”)
TRAVEL DETAILS:
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Describe your ideal vacation?
What Caribbean destinations have you been too?
What resort chains have you stayed at before?
Do you have a Caribbean island on your bucketlist? If so, which ones?
Have you been on a cruise? Which cruise line? And what did you like about the cruise?
What yould you like to do on your birthday vaca (i.e., party cruise, horseback riding, jet skiing,e etc.)
Anything I might of miss, you want to add?
Travel Preference:
*
Please select
All-Inclusive (air, hotel, r/t transportation)
Hotel only
Airfare only
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Cruise
Cruise + Airfare
Cruise + Airfare + Pre/Post Hotel
Which is your first preference for travel? Please note all travel will include basic travel protection unless you decide to upgrade or decline.
Room Preference:
*
Please select
Beachfront/Oceanfront
Swimout
Oceanview
Partial Oceanview
Pool
Garden
Total Guest Traveling:
Number of Adults
Number of Children under 16 years old
Do you or anyone else have any disabilities that require assistance?
Yes
No
Travel Time frame TO:
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MM
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DD
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Travel Time frame FROM:
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MM
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Budget per person:
$
Dollars
.
Cents
Thank you for taking the time to complete this form. Someone will follow-up once your travel details have been reviewed.