Travel Request Form
Thank you for choosing Via Lux Travel to assist you with your upcoming trip.
This information will help us find the best options to make your trip memorable. You can schedule a call to discuss your travel plans with us directly. If you have questions before we meet, you can reach us by email at info@vialuxtravel.com.
TRAVELER INFORMATION
Main Traveler Name (as it appears on your Passport or Government Issued ID)
*
First Name
Middle Name
Last Name
Phone Number
*
Format: (000) 000-0000.
Email
*
What type of travel services can we help you with? (select all that apply):
*
Group Travel
Cruise
Air & Hotel Packages
Train Tickets
Hotel/Villas
Event Tickets
Tours or Activities
Olympics
Other
What is your main travel style? (select the option that BEST fits your style)
Adventure
Luxury
Education/Culture
Active
Other
How many adults TOTAL will be on this trip? (including you)
*
How many children under 18 years of age will be on this trip?
*
Any special requirements or preferences we need to make accommodations for? (e.g., dietary restrictions, mobility limitations)
What is your budget/person for this trip?
*
*Per Person
What type of payment arrangement would you like?
*
Book Now, PAY NOW
Deposit Now, PAY INSTALLMENTS
TRAVEL DETAILS
Departure City
*
*Please list City, State AND Airport you prefer.
Destination
*
*Please list Cities and/or Countries you want to visit.
Type of Trip / Special Occasion (select all that apply)
*
Anniversary
Birthday
Business
Family Vacation
Girls/Guy Getaway
Honeymoon
Other
Preferred experiences on this trip. (select all that apply)
*
General sightseeing
Culinary tour or wine tastings
Local culture immersive experience
Active - cycling, hiking, skiing, kayaking, sailing
Other
Departure Date
*
/
Month
/
Day
Year
Return Date
*
/
Month
/
Day
Year
Are Your Dates Flexible?
*
Yes
No
ACCOMMODATIONS
Do you require accommodations (Hotel/Resort/Villa Rental)?
*
Yes
No
What type of accommodations do you prefer?
Please Select
Hotel
Resort
Villa/Vacation Rental
Number of Bedrooms or Hotel Rooms Needed
*
*Please list the number of rooms needed for your reservation.
Preferred amenities? (select all that apply)
Please Select
Pool
Beachfront
City location
Remote location
All-inclusive
Some meals included
Anything else you'd like us to know?
*Please indicate any other travel needs, details, health concerns or special requests for this trip.
Let's get to planning. Schedule a call below for us to talk about your trip.
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*
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