New Trip Inquiry

Full Name

First NameLast Name

Date of Birth

Date

Gender

MaleFemale

Email Address

example@example.com

Phone Number

Address

Street Address

CityState / Province

Postal / Zip Code

When is the best time to reach you?

What is the best way to reach you? (Email, phone call, text, etc.)

Total budget for trip:

Destination of interest:

Dates of travel?

Are these dates flexible?

YesNo

Let me know what your ideal trip looks like! Are there particular activities or attractions you want to experience? Do you prefer a more laid-back atmosphere, or are you looking for something with lively nightlife? Feel free to be as detailed as you’d like!

Do you have any mobility or accessibility needs?

Who will be traveling with you?

What type of accommodations are you looking for? (Please check all that apply.)

If you already have specific accommodations in mind, please list them below: (For example: hotel name, resort name, airline, etc.)

Do you have a passport?

We recommend considering travel insurance to protect against unexpected events. Would you like to purchase travel insurance for your trip?

Yes, I would like to purchase travel insurance.No, I choose not to purchase travel insurance at this time.Maybe, I would like you to tell me more about my options.

Terms and Conditions for Travel Services
1. Agreement to Terms: By submitting this form, you agree to the terms and conditions set forth herein.

2. Information Accuracy: You agree to provide accurate and complete information. Any changes to your travel plans must be communicated promptly.

3. Cancellation Policy: Cancellations must be submitted in writing. Refunds may vary depending on the supplier's policies and the timing of the cancellation. Please refer to individual supplier terms for specific cancellation fees.

4. Changes to Reservations: Any changes to your itinerary may incur additional fees. We will inform you of any costs associated with changes before processing.

5. Liability Disclaimer: While we strive to provide the best service, Riley Travel Co. is not liable for any loss, injury, or damage incurred while traveling. This includes but is not limited to:

Travel delays
Missed connections
Accidents or illness

6. Travel Insurace: We highly recommend that all clients purchase travel insurance to protect against unforeseen circumstances, including but not limited to trip cancellations, medical emergencies, and lost or stolen belongings. By signing this form, you acknowledge that you have been advised to consider travel insurance. If you choose not to obtain travel insurance, you understand that Riley Travel Co. will not be liable for any losses or expenses incurred as a result of your decision.

7. Governing Law: These terms shall be governed by and construed in accordance with the laws of the State of Nebraska.

8. Privacy Policy: Your personal information will be collected, stored, and used in accordance with our privacy policy. We will not share your information with third parties without your consent.

9. Acceptance of Terms: By signing this form, you acknowledge that you have read, understood, and agree to these terms and conditions.

Date Signed

Date

Client's Signature