Travel Request Form
Please complete all fields with details about your travel needs.
Thank you for allowing Luxx Travel Life to research your upcoming trip.
We will work to get you the best valued package available that meets your needs. Please provide as many details as possible to aid in the booking of your travel, and you will be contacted within 24-48 hours to discuss your trip in detail. Please contact Kayleigh Ramos with any questions by emailing
[email protected]
or calling (407) 984-6172.
TRAVELER INFORMATION
Main Traveler Name (as it appears on your Passport or Government Issued ID)
*
First Name
Middle Name
Last Name
Date of Birth
*
/
Month
/
Day
Year
Date Picker Icon
Phone Number
*
-
Area Code
Phone Number
E-mail
*
[email protected]
Please check the type of travel services you need (select all that apply):
*
Airline Tickets
Cruise
Hotel/Accommodations
Rental Car
Tours or Activities
Transportation To & From Hotel
Travel Insurance
Other
Type of Trip / Special Occasion (select all that apply)
*
Anniversary
Birthday
Business
Family Vacation
Getaway
Honeymoon
Other
What is your budget for this trip?
*
*Per Person
What type of payment arrangement would you like?
*
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TRAVEL DETAILS
Departure City
*
*Please list City & State or Airport you prefer.
Destination
*
*Please list City and/or country you want to visit.
Do you need multiple destinations?
*
Yes
No
What are the top 3 places that you are considering?
*
*Indicate what destinations you are interested in.
Departure Date
*
/
Month
/
Day
Year
Return Date
*
/
Month
/
Day
Year
Are Your Dates Flexible?
Yes
No
Click the Box
*
Save
Submit
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