Travel Questionnaire 2023

Travel Questionnaire

Please complete the following information
FULL NAME OF PRIMARY TRAVELER (as shown on passport)

First NameMiddle NameLast Name
DATE OF BIRTH

MonthDayYear
Date
MAILING ADDRESS

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
BILLING ADDRESS (if different than mailing address)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
CONTACT PHONE NUMBER - please indicate preferred contact number

Area CodePhone Number
EMAIL ADDRESS
example@example.com
CONFIRM YOUR EMAIL ADDRESS
example@example.com
PREFERRED METHOD OF COMMUNICATION
Name of Emergency Contact
Relationship of Emergency Contact
Phone Number of Emergency Contact

Area CodePhone Number
SPOUSE or SIGNIFICANT OTHER (if applicable) - Name, Relationship, Birthday, Anniversary
CHILDREN (if applicable) - Name, Relationship, Birthday
TRAVEL COMPANION(s) if relevant
Name(s) of Pets
What kind of pet and/or breed
How much does your pet weigh?
Do you often travel with your pets?
FLIGHT PREFERENCES
FAVORITE AIRLINE
Does anyone in your party suffer from motion sickness?
Does anyone in your party smoke?
Loyalty Programs
Program Name(s), Traveler Name(s), Number(s)
Hotel Questions
Favorite all-time hotel(s) anywhere in the world and why
Hotel style
Bedding Request

Other

Hotel Features: How important on a scale of 1 (least) to 5 (most)

General Travel Questions
Early risers or like to sleep in?
How adventurous are you on a scale of 1 to 5 (1 - not at all, 5 very adventurous)?
Favorite beach anywhere in the world
Best travel memory (location and activity)
Wish list destinations
Favorite meal away from home
Do you exercise on vacation or take a break? If exercise - what are your favorite activities?
Will do/won’t do: walking, hiking, biking, Segway, boating, helicopter, jet ski, sky dive (or other extreme sports), scuba dive, ATV, yoga
Favorite Snack
Favorite Beverage (non alcoholic)
Favorite Beverage (alcoholic)
Water
Other special interest (ie history buff/wine connoisseur/animal lover…?)
Allergies or physical limitations?

On a scale of 1-5 how important is

Thank you for taking the time to complete this questionnaire. I look forward to making your travel dreams come true. If there is any additional information you would like to share with me, please do so here
Travel Insurance
Please protect your investment in travel. Click HERE for more information and to obtain a Travel Insurance quote from Allianz. For best coverage, always ensure the full trip cost within two weeks of initial trip deposit & note that Cancel For Any Reason policies must be purchased on the date of your initial deposit.

Prior to international travel please be sure to have at least six months on your passport.
PAYMENT INFORMATION (if applicable)
When the time comes to collect payment we will send you a secure link to capture your credit card details and passport information.
Erica Gragg
Founder, Escape Artists: Luxury Travel Advisors
Specializing in private travel for discerning clients
An independent affiliate of Travel Edge, A Virtuoso Agency
IATA #:338 08 493
erica@escapeartiststravel.com
+1-415-299-7038 (mobile)

Follow us @escapetoshape + #escapetoshape + @ericagragg
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Travel Questionnaire