NEW CLIENT OA: Travel Assessment How did you hear about us?*Select oneGoogle/Web SearchFacebook/Social MediaCurrent/Past Agency ClientFriend/Family MemberWho? I would like to thank them for this referral. First Last Your name* First Last Your address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Preferred contact phone*Email* Contact Preferences - check all that apply* It's ok to text me It's ok to call It's ok to leave a message Total number of guests OVER the age of 12 travelingTotal number of guests UNDER the age of 12 travelingPreferred Destination(s)*Please note that certain personal legal issues can prohibit you from obtaining a passport and some countries will deny entry for past/current legal issues even if you hold a current passport. If you or someone in your group may have issues please let me know during our phone consultation or just type PASSPORT ISSUES in the above box so we can plan a vacation that everyone enjoys.Special things to consider (Check all that apply)* Mobility Issues Special Dietary requirements Someone in the group is Active Military, Retired Military, Fire, EMS or Police Someone in the group is pregnant There are no special circumstances to consider Start date for travel* Date Format: MM slash DD slash YYYY End date for travel* Date Format: MM slash DD slash YYYY Total vacation budget for your entire group:*Select one$2,500-$3,500 (Solo travelers or Continental United States$3,500-$5,000$5,000-$8,000$8,000-$10,000$10,000-$15,000$15,000-$20,000over $20,000My/Our Travel ExperienceVery little, stay close to homeUS travel only, lower 48 stateVisited Mexico, Caribbean Hawaii and/or CanadaTravel to multiple continentsAccommodation Preferences*Select oneI expect luxury accommodations and outstanding serviceI would like to try something unique like a castle, Yacht or luxury tree houseI prefer a condo, villa or houseI am okay with traditional accommodationsType of vacation we enjoy or would like to experience (check all that apply)* River cruise Luxury ocean cruise Small ship/motor yachting cruise (Caribbean/Mediterranean) U.S. river and/or Great Lakes cruise Expedition cruise (Polar regions/Galapagos Islands) Luxury European cruise (wine regions) Customized independent travel/tour Guided small group tour (average 16- 20 guests) Car & private driver tour Luxury all-inclusive resort Activities we enjoy while traveling (Check all that apply)* Sailing, boating, yachting Photography Sightseeing, walking tours Spa treatments Yoga Running/biking Hiking, kayaking, experiencing nature Scuba diving Snorkeling Experiencing local culture and cuisine Golf Fishing/hunting Shopping Relaxing poolside or at the beach Wine tasting, culinary classes Fine dining/ good wine Adventure activities: zip lining, rafting, etc Other Preferences (Check all that apply) I like to be close to the action and prefer a walkable location I prefer more privacy/seclusion and don't mind renting a vehicle to get around I prefer a room/location with an amazing view and will pay extra if necessary I require mobile/internet connection I prefer green/eco-friendly resorts Passports*Select oneWe all have valid passports that will expire more than 6 months after final date of travelome have valid passports that will expire more than 6 months after final date of travelNo one has a passport yet.I have no ideaAny additional requests/concerns you would like me to take into consideration when researching suggestionsPassenger Information*Please add a line for each traveler in your group. This information is required to generate accurate quotes from most suppliers. I must have complete information for all travelers in your group. If you are not comfortable providing this, please call me to discuss. I will not be able to proceed without this key information. First name from passportMiddle name from passportLast name from passportDate of birth
