Travel Request Form

Full Name*

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

E-mail*

example@example.com

Where would you like to go?*

Departure Date:*

Date

Return Date*

Date

Are your travel dates flexible?*

YesNo

If yes, state your alternate travel dates

What is your preferred departure airport?*

How many adults will be traveling?*

Name and D.O.B. of all adult travelers.

How many children will be traveling?

What are the children ages at time of departure?

Seat Preference

What is the per person budget?*

Ready to book?*

What best describes your hotel preference?

Will you be celebrating a special occasion? Please list the celebration.

Are you interested in excursions while on vacation?

You are aware that there is a non-refundable admin fee charged upfront for research services, trip coordination, and up to 2 quote revisions if needed. This fee could be a minimum of $25/per person or a one-time fee to be determined based on GROUP size. You will receive a separate invoice and this fee is NOT applied to your travel booking costs. If you DO NOT agree you will be directed to my website Book my own travel without my personal travel agent services.

I Agree to The Admin Fee, I Will Proceed to Book My Own Travel Visit (kimberlyburrell.inteletravel.com)

I agree to the admin fee*

YesNo

Would you be interested in learning how you can make money on the travel you're booking?*

YesNo

Signature

Your Ideal Vacation!