JULIE LIVE FOR TODAY TRAVEL INQUIRY FORM

GENERAL TRAVEL INQUIRY FORM

Thank you so much for reaching out to me! My services come at no extra cost to you! I will work hard to get you the best price available for your upcoming travel. Please fill out this form in it's entirety so I can better assist you. I will be in touch within 1 to 2 business days. Please add julie@livefortodaytravel.ca to your safe-sender list to prevent any email correspondence from going to your junk/spam folder.
JULIE BROEKEMA-BASSETT

TRAVEL AGENT
Name

First NameLast Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name*

First NameLast Name
Email*
Phone Number

Area CodePhone Number
Preferred Method of Contact - Check all that apply.*

EmailPhone CallText MessageFacebook Messenger
U.S. Military Involvement?*

NoNo but someone traveling with me isYes I am Active DutyYes I am RetiredYes I am a Military SpouseOther
Travel Information
Where would you like to go*
Departure Airport*
If not flying, put Driving from (city)
Travel Start Date*
Month/Day/Year
Travel End Date*
Month/Day/Year
Are your travel dates flexible?

YesNo
How many travelers age 18+*
Based on Travel Start Date
How many travelers age 10-17*
Based on Travel Start Date
How many travelers age 3-9*
Based on Travel Start Date
How many travelers age 2 or Under*
Based on Travel Start Date
If there are multiple families/couples traveling, how would you all like to be split into rooms? If anyone is military, please indicate which room they will be in!
Example: Room One = 2 adults & 5 year old, Room Two (military) = 1 adult & 8 year old, or We prefer a large suite that will sleep everyone, etc.
What is your Total Vacation Budget?*

$2,000 - $4,000$4,000 - $6,000$6,000 - $8,000$8,000 - $10,000$10,000+Other
What kind of Vibe are you looking for? Check All that Apply.*

Kid/Family FriendlyCulture/CulinaryAdventure/ActiveOff the Beaten PathRomanceRest & RelaxationNightlife/PartyHealth & WellnessClothing OptionalAdult Only SinglesAdult Only CouplesOther
Type of Travel? Check All that Apply.*

Family VacationWeddingSolo TravelHoneymoonBusiness TravelGirl's TripGroup TravelGuy's TripCouple's GetawayAll InclusiveCruiseDIsney VacationUniversal PackageFlight and hotel packageOther
Any Celebrations?

BirthdayAnniversaryGraduationOther
Anything you absolutely must see or do?
Example: Magic Kingdom, The Eiffel Tower, Snorkeling, Swim with Dolphins, Zip line, etc.
Anyone require handicap accessible accommodations, have special needs, dietary restrictions, allergies, or medical concerns you want me to be aware of?
Example: We need a wheelchair accessible room, child allergic to peanuts, etc. If multiple rooms - please indicate which
Any other Requests, Preferences, or Information you want me to know?
Example: We prefer to fly first class on Delta, ocean views, and a king size bed, etc.
Please verify that you are a human.*
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GENERAL TRAVEL INQUIRY FORM

JULIE BROEKEMA-BASSETT

Travel Information