Land Vacation Booking Client Intake Form
Provide your trip details, traveler information, and agreement to the booking terms to finalize your stay.
Trip & Agent Details
Agent Name
*
Please Select
Kathy Sheets
Joanne Davis
Client Primary Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Client Primary Email
*
example@example.com
Resort / Destination Name
*
Check-in Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Check-out Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Room / Accommodation Type
*
Please Select
Standard Room
Ocean View Room
Suite
Villa
Family Room
Other
Total Number of Travelers
*
Total Price
*
Deposit Amount
*
Deposit Due Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Final Payment Due Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Traveler Information
Traveler 1 Full Legal Name
*
First Name
Middle Name
Last Name
Traveler 1 Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Traveler 1 Passport Number
*
Traveler 1 Passport Expiration Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Traveler 1 Passport Issuing Country
*
Please Select
United States
Canada
Mexico
United Kingdom
Australia
Other
Traveler 1 Passport Photo/Scan
*
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Traveler 2 Full Legal Name
First Name
Middle Name
Last Name
Traveler 2 Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Traveler 2 Passport Number
Traveler 2 Passport Expiration Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Traveler 2 Passport Issuing Country
Please Select
United States
Canada
Mexico
United Kingdom
Australia
Other
Traveler 2 Passport Photo/Scan
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Traveler 3 Full Legal Name
First Name
Middle Name
Last Name
Traveler 3 Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Traveler 3 Passport Number
Traveler 3 Passport Expiration Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Traveler 3 Passport Issuing Country
Please Select
United States
Canada
Mexico
United Kingdom
Australia
Other
Traveler 3 Passport Photo/Scan
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Traveler 4 Full Legal Name
First Name
Middle Name
Last Name
Traveler 4 Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Traveler 4 Passport Number
Traveler 4 Passport Expiration Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Traveler 4 Passport Issuing Country
Please Select
United States
Canada
Mexico
United Kingdom
Australia
Other
Traveler 4 Passport Photo/Scan
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Travel Insurance
Travel Insurance
*
I ACCEPT travel protection insurance
I DECLINE travel protection insurance
Decline Waiver Initials
*
Terms and Conditions
Authorization to charge the payment method for the deposit and final payment on the specified dates
Acknowledgment that supplier policies govern cancellations, refunds, and changes, separate from service fees
Acknowledgment that dissatisfaction after services were rendered as booked does not justify a dispute
Agreement to direct complaints first to the resort or supplier and then to the travel agent before any dispute is filed
Acknowledgment that a completed passport copy for each traveler is required to finalize the booking and that name or passport errors are the traveler’s responsibility
Acknowledgment of reading and agreeing to all terms and conditions listed above
*
Signature
Typed Full Legal Name
*
First Name
Last Name
E-Signature
*
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Submit
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