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Simply Travel Travel Agents

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Enter traveler information

Primary Traveler

INCOMPLETE

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Contact Information"/>&#13;
		<field type="text" label="Prefix" name="prefix" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="First name" name="first-name" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Middle name" name="middle-name" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Last name" name="last-name" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Suffix" name="suffix" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Preferred name (nickname)" name="preferred-name" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Primary email address" name="email" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Primary phone number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Passport Information"/>&#13;
		<field type="text" label="Full name as it appears on passport" name="passport-name" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Passport number" name="passport-number" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Country of issue" name="passport-country-of-issue" subtype="text" className="form-control"/>&#13;
		<field type="date" label="Date of birth" name="birthday" className="form-control"/>&#13;
		<field type="date" label="Date of issue" name="passport-date-of-issue" className="form-control"/>&#13;
		<field type="date" label="Date of expiration" name="passport-date-of-expiration" className="form-control"/>&#13;
		<field type="radio-group" label="Gender" name="gender">&#13;
			<option label="F" value="female">F</option>&#13;
			<option label="M" value="male">M</option>&#13;
			<option label="X" value="other">X</option>&#13;
		</field>&#13;
		<field type="header" subtype="h2" label="Travel Preferences"/>&#13;
		<field type="radio-group" label="Seat preference" name="seat-preference">&#13;
			<option label="Window" value="window">Window</option>&#13;
			<option label="Aisle" value="aisle">Aisle</option>&#13;
			<option label="Opposite Aisle" value="opposite aisle">Opposite Aisle</option>&#13;
		</field>&#13;
		<field type="radio-group" label="Bed preference" name="bed-preference">&#13;
			<option label="King" value="king">King</option>&#13;
			<option label="2 Double/Queen" value="2-double-queen">2 Double/Queen</option>&#13;
		</field>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Contact Information"/>&#13;
		<field type="text" label="Prefix" name="prefix" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="First name" name="first-name" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Middle name" name="middle-name" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Last name" name="last-name" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Suffix" name="suffix" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Preferred name (nickname)" name="preferred-name" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Primary email address" name="email" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Primary phone number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Passport Information"/>&#13;
		<field type="text" label="Full name as it appears on passport" name="passport-name" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Passport number" name="passport-number" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Country of issue" name="passport-country-of-issue" subtype="text" className="form-control"/>&#13;
		<field type="date" label="Date of birth" name="birthday" className="form-control"/>&#13;
		<field type="date" label="Date of issue" name="passport-date-of-issue" className="form-control"/>&#13;
		<field type="date" label="Date of expiration" name="passport-date-of-expiration" className="form-control"/>&#13;
		<field type="radio-group" label="Gender" name="gender">&#13;
			<option label="F" value="female">F</option>&#13;
			<option label="M" value="male">M</option>&#13;
			<option label="X" value="other">X</option>&#13;
		</field>&#13;
		<field type="header" subtype="h2" label="Travel Preferences"/>&#13;
		<field type="radio-group" label="Seat preference" name="seat-preference">&#13;
			<option label="Window" value="window">Window</option>&#13;
			<option label="Aisle" value="aisle">Aisle</option>&#13;
			<option label="Opposite Aisle" value="opposite aisle">Opposite Aisle</option>&#13;
		</field>&#13;
		<field type="radio-group" label="Bed preference" name="bed-preference">&#13;
			<option label="King" value="king">King</option>&#13;
			<option label="2 Double/Queen" value="2-double-queen">2 Double/Queen</option>&#13;
		</field>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>

Continue to traveler info

Simply Travel Travel Agents

Travel Agent Fee —

—

Convenience fee —

Total —

Due now —

Continue to traveler info

How would you like to pay?

Payment Type

Credit card

Bank transfer (save $13.20)
Your bank info will be collected on the next page.

Payment schedule

Pay deposit

Deposit of $0.00 due on January 12, 2025

Monthly Payment #1 of $44.40 due on February 1, 2025

Monthly Payment #2 of $44.40 due on March 1, 2025

Monthly Payment #3 of $44.40 due on April 1, 2025

Monthly Payment #4 of $44.40 due on May 1, 2025

Monthly Payment #5 of $44.40 due on June 1, 2025

Monthly Payment #6 of $44.40 due on July 1, 2025

Monthly Payment #7 of $44.40 due on August 1, 2025

Monthly Payment #8 of $44.40 due on September 1, 2025

Monthly Payment #9 of $44.40 due on October 1, 2025

Monthly Payment #10 of $44.40 due on November 1, 2025

Final Payment of $44.35 due on December 1, 2025

$0.00

Save time and turn on auto-pay?

Yes, turn on auto-pay. I agree that future payments on this invoice will be charged automatically on the due dates indicated in the payment schedule.

Pay full amount

$485.28

Note: By paying, you agree to the following Terms & Conditions

Terms & Conditions

I authorize Simply Travel to charge the credit card or bank account indicated on this invoice for the noted amount on today's date. This payment is for the services described on the invoice. I understand that all payments made to Simply Travel are non-refundable. I certify that I am an authorized user of this credit card and that I will not dispute the payment with my credit card company, so long as the transaction corresponds to the terms indicated on this invoice.

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Simply Travel Travel Agents

Travel Agent Fee —

—

Convenience fee —

Total —

Due now —

Continue to traveler info

Simply Travel Travel Agents

Select travelers

Select your package

Travel Agent Fee

Available until December 1, 2025 - available

$468.00
Deposit: $39.00 per person

Enter traveler information

Primary Traveler

INCOMPLETE

Simply Travel Travel Agents

Simply Travel Travel Agents

How would you like to pay?

Payment Type

Credit card

Bank transfer (save $13.20)
Your bank info will be collected on the next page.

Payment schedule

$0.00

Save time and turn on auto-pay?

Pay full amount

$485.28

Terms & Conditions

Simply Travel Travel Agents

Simply Travel Travel Agents

Select travelers

Select your package

Travel Agent Fee Available until December 1, 2025 - available

$468.00 Deposit: $39.00 per person

Enter traveler information

Primary Traveler

INCOMPLETE

Simply Travel Travel Agents

Simply Travel Travel Agents

How would you like to pay?

Payment Type

Credit card

Bank transfer (save $13.20) Your bank info will be collected on the next page.

Payment schedule

$0.00

Save time and turn on auto-pay?

Pay full amount

$485.28

Terms & Conditions

Simply Travel Travel Agents

Travel Agent Fee

Available until December 1, 2025 - available

$468.00
Deposit: $39.00 per person

Bank transfer (save $13.20)
Your bank info will be collected on the next page.