TravelJoy

Team Travelooza

Travelooza

23-01 BLT4B Viking West Indies

Jan 30, 2023 to Feb 11, 2023

Sailing West Indies

<form-template>
	<fields>
		<field type="header" subtype="h1" label="DEPOSIT INFORMATION FOR VIKING GROUP CRUISE&amp;nbsp;"/>
		<field type="paragraph" subtype="p" label="Congratulations, we are to the final booking stage of your vacation! I would like to make your vacation hassle free and finalizing accurate paperwork is an essential step. In an effort to ensure proper travel documentation requirements are met and security issues are avoided; please complete the following form fully and accurately. All submitted information is secure, properly protected, and used exclusively for your upcoming reservation. It comes only to me, Jana Huse, via email and then I will input to confirm the reservation."/>
		<field type="text" required="true" label="Person Making the reservation: First Name" name="first-name" subtype="text" className="form-control"/>
		<field type="text" label="Middle name" name="middle-name" subtype="text" className="form-control"/>
		<field type="text" required="true" label="Last name" name="last-name" subtype="text" className="form-control"/>
		<field type="text" label="Suffix" name="suffix" subtype="text" className="form-control"/>
		<field type="text" required="true" label="Best Contact Phone while traveling:" name="phone-number" subtype="text" className="form-control"/>
		<field type="text" required="true" label="Email" name="email" subtype="text" className="form-control"/>
		<field type="text" label="Address Line 1" name="address-line-1" subtype="text" className="form-control"/>
		<field type="text" label="Address Line 2" name="address-line-2" subtype="text" className="form-control"/>
		<field type="text" label="City" name="address-city" subtype="text" className="form-control"/>
		<field type="text" label="State" name="address-state" subtype="text" className="form-control"/>
		<field type="text" label="Zip" name="address-zip" subtype="text" className="form-control"/>
		<field type="date" required="true" label="First Passenger Birthday" name="birthday" className="form-control"/>
		<field type="header" subtype="h2" label="Passport Info"/>
		<field type="text" label="Full name as it appears on passport" name="passport-name" subtype="text" className="form-control"/>
		<field type="text" label="Passport number" name="passport-number" subtype="text" className="form-control"/>
		<field type="text" label="Country of issue" name="passport-country-of-issue" subtype="text" className="form-control"/>
		<field type="date" label="Date of issue" name="passport-date-of-issue" className="form-control"/>
		<field type="date" label="Date of expiration" name="passport-date-of-expiration" className="form-control"/>
		<field type="radio-group" label="Gender" name="gender">
			<option label="F" value="female">F</option>
			<option label="M" value="male">M</option>
			<option label="X" value="other">X</option>
		</field>
		<field type="text" label="Place of birth" name="place-of-birth" subtype="text" className="form-control"/>
		<field type="text" label="Nationality" name="nationality" subtype="text" className="form-control"/>
		<field type="text" label="Citizenship" name="citizenship" subtype="text" className="form-control"/>
		<field type="text" label="SECOND PASSENGER NAME AS ON PASSPORT" description="First Middle Last" name="second-passenger-name-as-on-passport" subtype="text" className="form-control"/>
		<field type="text" label="SECOND PASSENGER BIRTHDATE" description="MM/DD/YYYY" name="second-passenger-birthdate" subtype="text" className="form-control"/>
		<field type="text" label="SECOND PASSENGER PASSPORT NUMBER" description="If you don't have passports yet  please just send over this information when you get them." name="second-passenger-passport-number" subtype="text" className="form-control"/>
		<field type="text" label="SECOND PASSENGER PASSPORT ISSUE DATE" description="MM/DD/YYYY" name="second-passenger-passport-issue-date" subtype="text" className="form-control"/>
		<field type="text" label="SECOND PASSENGER PASSPORT EXP DATE" description="MM/DD/YYYY" name="second-passenger-passport-exp-date" subtype="text" className="form-control"/>
		<field type="paragraph" subtype="p" label="TRAVEL PROTECTION"/>
		<field type="paragraph" subtype="p" label="I believe that your upcoming trip is a significant investment which you should protect. For this reason, I strongly recommend you purchase Travel Insurance. If you choose to decline this valuable protection, you are assuming any financial loss associated with your travel arrangements. Travel insurance purchases will be done prior to final payment."/>
		<field type="select" required="true" label="Our choice for travel insurance&amp;nbsp;" description="NOTE: If you choose Viking TripMate coverage  payment will need to be made along with the $500 per person deposit  If you choose and Allianz policy  purchase now if pre-existing conditions or up to final payment date otherwise." name="our-choice-for-travel-insurance-" className="form-control">
			<option label="I would like to purchase Viking TripMate TPP policy per the quote at this time." value="i-would-like-to-purchase-viking-tripmate-tpp-policy-per-the-quote-at-this-time" selected="true">I would like to purchase Viking TripMate TPP policy per the quote at this time.</option>
			<option label="I would like to purchase the Cancel For Any Reason policy per the Allianz quote I received at this time" value="i-would-like-to-purchase-the-cancel-for-any-reason-policy-per-the-allianz-quote-i-received-at-this-time">I would like to purchase the Cancel For Any Reason policy per the Allianz quote I received at this time</option>
			<option label="I would like to purchase the Classic Policy per the Allianz quote I received at this time." value="i-would-like-to-purchase-the-classic-policy-per-the-allianz-quote-i-received-at-this-time">I would like to purchase the Classic Policy per the Allianz quote I received at this time.</option>
			<option label="I will wait and make my decision at time of final payment." value="i-will-wait-and-make-my-decision-at-time-of-final-payment">I will wait and make my decision at time of final payment.</option>
			<option label="I do not wish to purchase travel insurance." value="i-do-not-wish-to-purchase-travel-insurance">I do not wish to purchase travel insurance.</option>
			<option label="Other" value="other">Other</option>
		</field>
		<field type="text" required="true" label="Airport prefer to fly from&amp;nbsp;" name="airport-prefer-to-fly-from-" subtype="text" className="form-control"/>
		<field type="select" label="For seat assignments, do you prefer aisle or window seat?" name="for-seat-assignments-do-you-prefer-aisle-or-window-seat" className="form-control">
			<option label="Aisle/Middle" value="aislemiddle" selected="true">Aisle/Middle</option>
			<option label="Window/Middle" value="windowmiddle">Window/Middle</option>
			<option label="Aisle/Aisle across from each other" value="aisleaisle-across-from-each-other">Aisle/Aisle across from each other</option>
			<option label="Other" value="other">Other</option>
		</field>
		<field type="textarea" label="Do you prefer a certain airline, if available? If you have frequent flyer numbers you would like to use please include." name="do-you-prefer-a-certain-airline-if-available-if-you-have-frequent-flyer-numbers-you-would-like-to-use-please-include" className="form-control"/>
		<field type="textarea" label="Are you interested in upgrade pricing for your flight such as economy plus, stretch seating or business class?" name="are-you-interested-in-upgrade-pricing-for-your-flight-such-as-economy-plus-stretch-seating-or-business-class" className="form-control"/>
		<field type="paragraph" subtype="p" label="PAYMENT AUTHORIZATION"/>
		<field type="paragraph" subtype="p" label="I have authorized Jana Huse with Travelooza to charge deposits/trip costs as listed below by processing with the appropriate Supplier to my credit card/bank account as detailed below:"/>
		<field type="text" required="true" label="Payment Amount authorized for the Initial Deposit. (minimum $500 person)" description="The deposit is the amount required to initiate a reservation on your behalf." name="payment-amount-authorized-for-the-initial-deposit-minimum-500-person" subtype="text" className="form-control"/>
		<field type="text" label="Remaining Balance authorized to be charged to this card by final payment deadline" description="This is the total remaining balance due. If unsure of the amount  enter 0.00. **If you intend to pay using a different card for final payment  a new credit card authorization form is required to be submitted at least 48 hours before the final payment due date." name="remaining-balance-authorized-to-be-charged-to-this-card-by-final-payment-deadline" subtype="text" className="form-control"/>
		<field type="text" label="Please do payment via eCheck for 3.3% discount-- Routing number:" name="please-do-payment-via-echeck-for-33-discount-routing-number" subtype="text" className="form-control"/>
		<field type="text" label="Bank Account number:" name="bank-account-number" subtype="text" className="form-control"/>
		<field type="paragraph" subtype="p" label="Please provide a contact to be used for airlines and such when traveling."/>
		<field type="paragraph" subtype="p" label="EMERGENCY CONTACT INFORMATION"/>
		<field type="text" label="Name" name="name" subtype="text" className="form-control"/>
		<field type="text" label="Address" name="address" subtype="text" className="form-control"/>
		<field type="text" label="Phone" name="phone" subtype="text" className="form-control"/>
	</fields>
</form-template>