Customer Intake Form

Customer Intake Form
Full Name

First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Home Address:
Vacation Type (cruise, resort):
Desired Destination:
Dates of travel:
Departure Airport & Seating Preference
Number of adults:
Number of children and ages:
Vacation Budget:
Special Occasion (honeymoon, birthday, anniversary)
Desired Activities:
Hotel Preferences/Accomodations:
All custom research, itinerary planning, and design fees are strictly non-refundable, as they compensate for professional time and services rendered, regardless of whether the final trip is booked or completed. Should you cancel or modify your confirmed booking, any payments made are subject to third-party supplier (airline, hotel, tour operator) penalties and rules. In addition, Journey 4 Life Travel Agency assesses a research, and cancellation/change processing fee of $30 per person/family. By providing payment information or approving your itinerary, you acknowledge and agree to these non-refundable terms.

Sign below to acknowledge you agree to the terms above:
Signature Date*
My Products
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Research Fee
$30.00

Total

$0.00

Debit or Credit Card

Choose from one of the PayPal options to make your payment.