Client Qualified

Client Qualified Form

Contact Us

Today's Date

Primary Passenger Name (Must have name exactly as it appears on passport, including middle names)

Address

City

State

Zip+4

DOB

Home Phone

Cell Phone

Email 1

Email 2

Free Text

Additional Passenger Names w/ DOB & Relationship (Full Names)

Mailing List

Yes

1. Name

DOB

2. Name

DOB

3. Name

DOB

4. Name

DOB

5. Name

DOB

6. Name

DOB

Type of Travel

Region you are interested in

First requested date of travel

Second choice

Date requested return

Second choice

Total Amount of Travel Insurance (Please Initial)

Do you and/or traveling companions have passports?

Yes

How many people in one room

View/Type of Room

Free Text

Additional nights before/after our Cruise/Tour?

No. of Pre nights

Post nights

Special requests

Special meals (detail)

Medical Needs

Free Text

QUOTE INFORMATION

Segment Type

Supplier

Departure Date

Return Date

Pax #

Base Price +

Taxes/Fees =

Total Quote

Confirmation Number

Name on Credit Card

Credit Card #

Exp

CVV

Deposit Amount

Deposit Date

Final Due Date

I authorize charges for the deposit and/or final payment on the credit card listed above (Full Name in Print)

Contact Information

Phone:

(727) 953-3591

Email:

donald@serenity-travel.com

Address:

472 Clearwater Largo Rd Largo Florida 33770-2336, United States

Business Hours

Mon - Fri: 10:00 am - 5:00 pm
Sat - Sun: Appointment Only