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Client Service Questionaire

Name (required)
Mailing Address
City, State, Zip
Evening Phone
Daytime Phone (required)
Fax #
e-Mail Address (required)
Passport Number (USA)
Passport - other country
Birthdate
Anniversary Date
Companion's name
Companion's birthdate
Children's legal names and birthdates

Vacation Specifics

Usual Vacation Length How often? (frequency)
List calendar restrictions, if any.

Where have you traveled?

Check all that apply.

Hawaii

Asia

Mexico

Africa

Canada

Alaska

Europe

Australia New Zealand

Caribbean

Latin America

Other: Specify

Where would you like to travel? Check all that apply.

Hawaii

Asia

Mexico

Africa

Canada

Alaska

Europe

Australia New Zealand

Caribbean

Latin America

Other: Specify

Do you prefer: Escorted or Independent travel? (Check One)
What tour operators have you utilized in the past?
Were you satisfied with their services?
Preferred airports: First choice:   Second Choice:
Class of Service preferred

Coach     Business Class     First Class

Red-eye flights ok? Yes    No
Seat Preferences: Window    Aisle    Aisles across (w/companion)
  Foreward of wing    Over wing    Behind wing
Frequent flyer numbers:
List Airline & Number
Frequented destinations, Domestic

Hotel Preferences

Preferred Class of Hotel Economy    Moderate    Business Class    Luxury
List Frequent Stay Programs by Hotel and Number
Room type preferred One bed    Two beds    Suite
  Smoking    Non-smoking
Special needs: Handicapped access    On-site gym    Pool/spa    Jacuzzi
  Restaurant    Lounge    Balcony    Other:

Auto Preferences

Car Type Economy   Compact   Standard/Mid-size   Luxury | 2-door 4-door
Specialty Vehicle Van   SUV ;  Convertable   Recreational Vehicle Other
Discount programs AARP #   Sams Club #   AAA#
Corporate Affiliations

Cruise Information

Have you cruised before? Yes    No
If yes, what cruise lines?
Cabin Type preferred Inside    Ocean View Balcony   Suite
Preferred location of cabin
Have you sailed on Riverboats   Yacht   Sail boat   Cruise Liner
What do you like best about cruising?
What do you like least about cruising?
Please rate the following in importance
Activity Extremely important Very important Important Not very important Unimportant
Children's programs
On-board gambling
Daily Stops
At Sea Days
On-board Activities
On-board Entertainment
Flexible dining options
Dancing Options
Room Service
Open Bar
Cabin Size
Other

Please press the Submit button to submit this form.

 

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Hearts on the Go - A Division of Cordially Yours Travel - California Seller of Travel CST-1013939-40
4400 Duncan Hills Road., PO Box 216, Rescue, CA 95672
Office Phone: 530-676-7430 - Toll-Free 1-866-877-TRIP (8747) - Office Fax: 530-676-3758 - Email: info@heartsonthego.com
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