VWR Travel Booking Request Form

Travel Booking Request Form
Primary Passenger Contact Info

First NameLast Name
Best Contact Number

Area CodePhone Number
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail
Total Number Of Adults
Adults Names, DOB, Gender (M/F)
Total Number Of Children
Children Names, DOB, Gender (M/F)
Special Occassion (Birthday, Honeymoon, Destination Wedding, Music Festival, ...
Destination
Preferred Hotel . Resort
Adult Only Or Kid Friendly
Include Flight
Preferred Airport to leave and return to?
Flight Seat Preference
Number Of Rooms
Start Travel Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
End Travel Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Is Date Flexible?
King / Double /Suite /Penthouse
Special Rates AAA, Military, Government, etc
Transportation To And From Hotel
Cabin Type (Cruise Only)
Porting From (Cruise Only)
Preferred Cruise Line (Cruise Only)
Have You Been On A Cruise Before? (Cruise Only)
If Yes, Which Cruise Line?
Estimated Trip Amount (US Dollars) per person (Budget)
Is Anyone Traveling Over The Age Of 55?
Does Anyone Traveling Have A Military Background?
Special Instructions
Activities: Spa, Golf, Excursion, Activities, Event Ticket, Shows, etc
Include Travel Insurance
Is your trip within 90 days?
If you select Yes, your payment may be due in full at time of booking
Payment Selection
If Payment Plan is selected and it’s within 90 days of your intended travel date, beware this might not be an option for you unless you go through Uplift and are approved for a loan.
Are you deposit ready? (Could be 25% of total trip)
Please remember if your trip is in less than 90 days, the deposit amount will be higher or full payment could be due at time of booking.
How did you hear about my travel service?
I charge a non refundable $25 research fee. Once this fee and form have been collected, I will provide at least 3 quotes to the email you provided within 48 hours. Due to the strict contracts that we have vendors, I can only hold quoted prices for no more than 48 hours. At that time, either deposit or full payment will be due at time of booking. Do you understand?
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