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Please provide us as much information as possible. If requirements are unknown, please write N/A or "Unknown"

Travel Agency

Travel Agent Name

Email Address

Phone number

Agent contact number

Is this an urgent request?

Yes

Reason for Urgency

Preferred Supplier 1

Please select your preferred supplier from the drop down box

Preferred Supplier 2

Select another preferred supplier from the drop down box

Client Names

Please include total number of passengers including children and their age at time of travel.

Dates and duration

Please include the year

Destinations:

Brief description or areas to be visited including countries and cities

Category and style of accommodation

5 star, 4 star, B&B style, Boutique etc

Room Configuration

Twin Double, triple, interconnecting etc

Accommodation requests

Please list the names of any requested accommodation

Budget

Please supply us with a NETT land ONLY budget. Please note: Quotations from a DMC will be NETT, please ensure you leave a margin for your commission.

Currency of budget:

Budget is:

NETT - Per Night

NETT - Per Person

NETT - Total

I understand these prices are NETT and non-commissionable for land only products

Yes

Would you like assistance regarding internal flights?

Please note: Flights will be quoted separately.

Yes

Interests

Sightseeing, Culture, Cuisine, etc

Activities requested

Cycling, horse riding, helicopter flights, visit to a local school etc

Approximate age and fitness

First time to destination?

Yes

Flights

Please include any flight details, if unknown as yet, include departure city and airline.

Other comments

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