CPLTC Questionnaire
908-681-4039 www.leisuretimecruises.com
Your Full Name as it appears on passport
*
First Name
Middle Name
Last Name
Birthdate
*
-
Month
-
Day
Year
Date
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Traveling Spouse or Travel Partner full name as it appears on passport
*
First Name
Middle Name
Last Name
Traveling Spouse or Traveling Partner Birthdate
-
Month
-
Day
Year
Date
Traveling Spouse or Traveling Partner Email
example@example.com
Traveling Spouse or Traveling Partner Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What type of vacation
*
Land
Cruise
What type of lodging accommodations do you prefer
*
3 Star
4 Star
5 Star
How many days ?
*
Travel date
*
-
Month
-
Day
Year
Date
If a group how many people will be traveling with you?
Please list the full names of all parties as they appear on passport including birthdates, email address and phone numbers
List full name, Birthdates, email address and phone number
What is your budget for the trip? Please consider accommodations, transportation, and activities?
*
Are you celebrating any special occasion
*
What are your destinations or countries you'd like to visit?
*
Are there any special needs or specific activities, excursions, cultural or historical sites you'd like to visit during your trip?
*
Do you need air?
*
Airport or City you would like to leave from
*
Are your passports valid and up to date? (Must be valid for 6 months post return)
*
Yes
No
Did anyone serve in the military?
*
Yes
No
Indicate the name of the persons that served in the military
Are you interested in travel insurance?
*
Yes
No
Submit
Should be Empty: