GalaxSea Vacation Questionnaire
Your Name
Trip Name
Your Travel Advisor's Name
Phone
Your Email
Address
City
State
Zip code
Have you used our services before?
Yes
No
Unsure
If you haven't used us before, how did you hear about us?
If you have been referred to us, please give us your friend's name.
Where are you looking to travel?
How long do you plan to be gone?
When are you looking to travel?
Are your dates flexible?
Yes
No
If your dates are flexible, provide further explanation
What type of travel are you looking for?
Resort / Hotel Stay
Cruise / River Cruise
All-Inclusive Resort Stay
Customized Travel Arrangements
Planned Touring Package
I only need airfare with a car rental or hotel
Do you plan to fly?
Yes
No
Where do you prefer to fly from?
How many adult travelers?
1
2
3
4
5
6
7
8
More than 8
How many children under age 12?
1
2
3
4
5
6
7
More than 7
Any infants under 2?
1
2
More than 2
How many rooms do you need?
1
2
3
4
5 or more
Is anyone celebrating a special occasion?
Please select
Honeymoon
Destination Wedding
Anniversary
Birthday
Graduation
Other
Please select
What date is the occasion?
How soon will you be ready put a down payment on your trip?
Today / This week
Within a few weeks
More than two weeks away
Which best describes your vacation desires?
I'm looking for a hassle free trip that fits into my budget
This is a trip of a lifetime for me, I want to do things right
I'm more experienced at travel and know what I want
I'm looking for GalaxSea's experience and knowledge to guide me to the best value
Are you working with a specific budget?
Please select
Yes
No
I need guidance on pricing
Please select
What is the budget?
Please select
Under $1000 per traveler
$1001-$1500 per traveler
$1501-$2000 per traveler
$2000-$3000 per traveler
$4000 or more per traveler
Please select
How do you wish to pay for our services? Please see more on this on our website page titled "start here", or ask for a copy of our Agency Brochure.
Inclusive Travel Professional Plan - $150
VIP Concierge Service Plan - $450
Plan To Go fee - $50
Do you have any important information or needs we should know about?
Give us the Traveler Name(s) and information here.
Name spelling should match passport or driver's license
Traveler Name
Passport Number
Date of Birth (MM/DD/YYYY)
Expiration Date (MM/DD/YYYY)
Gender
Male
Female
Male
No Passport
Add Another Traveler
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20