Client Intake Form

Main Traveler Contact Information

Please enter your full legal name as it appears on your passport.
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Gender (as it appears on your passport) *
 
Are you celebrating anything special with this trip (honeymoon, birthday, anniversary, etc)? *
What are you celebrating? *
 
Is anyone in the reservation present or past Law Enforcement, Military or IAFF Union Member?
Are you vaccinated against COVID-19?
Should your travel destination requirements change, Vic will reach out to discuss vaccination status and options. *
 
If you have TSA Precheck or any airline frequent flyer numbers (for the airline you will be flying for this trip), please enter those here.
 Member #Description
TSA Pre Check
Airline Member #
Airline Member #
Other
Other

Additional Travelers

Additional Traveler #1
 Additional Traveler #1
*First Name
*Middle Name
*Last Name
*Date of Birth (mm-dd-yyyy)
*Gender
Vaccinated against COVID-19?
TSA Precheck # (if applicable)
Airline Frequent Flyer # (if applicable)
Other Info
Additional Traveler #2
 Additional Traveler #2
*First Name
*Middle Name
*Last Name
*Date of Birth (mm-dd-yyyy)
*Gender
Vaccinated against COVID-19?
TSA Precheck # (if applicable)
Airline Frequent Flyer # (if applicable)
Other
Additional Traveler #3
 Additional Traveler #3
*First Name
*Middle Name
*Last Name
*Date of Birth (mm-dd-yyyy)
*Gender
Vaccinated against COVID-19?
TSA Precheck # (if applicable)
Airline Frequent Flyer # (if applicable)
Other
Additional Traveler #4
 Additional Traveler #4
*First Name
*Middle Name
*Last Name
*Date of Birth (mm-dd-yyyy)
*Gender
Vaccinated against COVID-19?
TSA Precheck # (if applicable)
Airline Frequent Flyer # (if applicable)
Other
Additional Traveler #5
 Additional Traveler #5
*First Name
*Middle Name
*Last Name
*Date of Birth (mm-dd-yyyy)
*Gender
Vaccinated against COVID-19?
TSA Precheck # (if applicable)
Airline Frequent Flyer # (if applicable)
Other
Additional Traveler #6
 Additional Traveler #6
*First Name
*Middle Name
*Last Name
*Date of Birth (mm-dd-yyyy)
*Gender
Vaccinated against COVID-19?
TSA Precheck # (if applicable)
Airline Frequent Flyer # (if applicable)
Other
Additional Traveler #7
 Additional Traveler #7
*First Name
*Middle Name
*Last Name
*Date of Birth (mm-dd-yyyy)
*Gender
Vaccinated against COVID-19?
TSA Precheck # (if applicable)
Airline Frequent Flyer # (if applicable)
Other
Additional Traveler #8
 Additional Traveler #8
*First Name
*Middle Name
*Last Name
*Date of Birth (mm-dd-yyyy)
*Gender
Vaccinated against COVID-19?
TSA Precheck # (if applicable)
Airline Frequent Flyer # (if applicable)
Other
Additional Traveler #9
 Additional Traveler #9
*First Name
*Middle Name
*Last Name
*Date of Birth (mm-dd-yyyy)
*Gender
Vaccinated against COVID-19?
TSA Precheck # (if applicable)
Airline Frequent Flyer # (if applicable)
Other
Additional Traveler #10
 Additional Traveler #10
*First Name
*Middle Name
*Last Name
*Date of Birth (mm-dd-yyyy)
*Gender
Vaccinated against COVID-19?
TSA Precheck # (if applicable)
Airline Frequent Flyer # (if applicable)
Other
I have confirmed the spelling of names and birth dates for all travelers, including myself, is correct as I entered it above. I understand if I have any incorrect information submitted on this form, I may be subject to change fees from the airline. *

Passport Information

To travel internationally, you must have a passport BOOK that is valid through at least 6 months beyond your travel dates.  A passport card is not a valid passport for entry to another country.
 
Cruises that start and end in the US, as well as domestic travel, do NOT require a passport book, and a passport card can work as a form of identification, but ANY international travel must have a book. 
Passports: *
 

By e-signing below, I understand that I will need a passport book if I am traveling internationally.  (For domestic travelers, please draw an X in the box). *
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Payment Information

Please submit the credit card that you would like to use to pay for your trip. Should you need to update/change your credit card details at a later time, you may contact Vic directly to make these changes.
Please be advised by agreeing to book this trip, you are agreeing to allow me to make credit card charges on your behalf. These charges will only be on the credit card you have provided, and will be made at deposit, final payment, and any other payments you direct me to make.
Visa
By e-signing below, I have read and accept the terms of the Credit Card Authorization Form*
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E-Signatures

Select your vacation provider/destination: *
SANDALS TRAVEL INSURANCE
My trip is: *
Sandals is automatically providing travel insurance for all trips through December 2022.
Please select if you would like to purchase travel insurance. If you accept, Vic will send you a travel insurance quote through ARCH after your trip is booked. *
SANDALS & NON-SANDALS SPLIT STAY TRAVEL INSURANCE
Sandals is automatically providing travel insurance for all trips through December 2022.
Vic will contact you to discuss your travel insurance options. In general... *
DISNEY TRAVEL INSURANCE
Please select your travel insurance option: *
TRAVEL INSURANCE FOR EUROPE TRIPS
Please select if you would like to purchase travel insurance. If you accept, Vic will send you a travel insurance quote through ARCH after your trip is booked. *
EXCELLENCE RESORTS TRAVEL INSURANCE
Please select if you would like to purchase travel insurance. If you accept, Vic will send you a travel insurance quote through ARCH after your trip is booked. *
TRAVEL INSURANCE
- Read more about credit vs. cash back insurance
- Watch Vic's Video about travel insurance
 
- TRIP CREDIT travel insurance - If you cancel for any reason you will receive a credit through the supplier you have your trip booked through that can only be used with that supplier. There will not be an option for cash back.
- CASH BACK travel insurance - typically 150% more expensive to purchase than a travel credit policy.
- DECLINING travel insurance - I recommend travel insurance on all trips, especially when leaving the country. Keep in mind that you purchase insurance for the unforeseen circumstances that could arise during your trip, which are typically significantly more expensive than the cost of travel insurance.
Please choose the type of travel insurance you would like to purchase. *
By signing below, I certify that I have read and understand the travel insurance options presented to me. I am signing on behalf of my entire traveling party. I agree to PURCHASE the type of travel insurance that I selected in my response above. *
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Are you sure you want to decline travel insurance? *
By signing below, I certify that I have read and understand the travel insurance options presented to me. I am signing on behalf of my entire traveling party. I DECLINE the opportunity to purchase travel insurance to protect my trip. *
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Please note that you have declined travel insurance through the supplier of your trip.  There is an opportunity to purchase 3rd party travel insurance at a later time, however, please note that this will not cover any reimbursement for pre-cancellation (i.e. if you cancel your trip prior to going for any non-covered medical reason there will be no reimbursement). However, if you choose to add 3rd party travel insurance later to cover accidentals on your trip, you may do so.
COVID-19 TRAVEL WAIVER
Please note that COVID-19 is an evolving element within travel. Your plans may be impacted by COVID-19 and that will be something entirely out of my control as your agent, as well as yours as a traveler. I am here to advise you on travel policies as they pertain to COVID-19, but I cannot control them.
By signing below, I certify that I have read and accept the terms of the COVID-19 Travel Waiver. I am signing on behalf of my entire traveling party. *
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TERMS AND CONDITIONS
By signing below, I certify that I have read and accept the Terms and Conditions and the Client Agreement with Vic's Vacations and Bethany Travel. I am signing on behalf of my entire traveling party. *
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Additional Information

Thank you for filling out this form.  I look forward to booking your trip!!
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