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We would like to know more about you. Please fill out this form or contact us today.

PERSONAL INFORMATION * - required information
* First Name
* Last Name
* Address

* City
* State
* Zip
* Country
I would like to receive vacation offers via:
	email mail both I do not wish to receive vacation offers at this time
* Phone Number
Mobile Number
Fax Number
* Email Address
Age Range	Under 3535 - 5051 - 6566 and over
Gender	MaleFemale
Status	Single Married -- Spouse/significant other name: -- Anniversary: Young Family Retired

PAST LEISURE TRAVEL INFORMATION
Frequency of Leisure Travel	Once per year Two or Three trips per year Four or Five trips per year Six or more trips per year
Average length of leasure vacation	Ten days or less 11-20 days Over 20 days
Average Budget per person, per leisure vacation	Up to $3,000 $3,000 - $8,000 $8,000 - $15,000 Over $15,000

LEISURE TRAVEL PREFERENCES
I prefer or would like more information about (check all that apply)
Cruising	Barging Expedition Cruising River Cruising Small Ship Trans Atlantic World Voyages
Escorted Tours	Private Tours (My party only) Group Tour Full Itinerary Relaxed Itinerary Family Vacations Private Jet Vacation
Lodging	Hotels Ranch/Lodges Resorts Spas Rail Travel Short Notice Travel
I have traveled to or would like more information about (check all that apply)
	Africa Alaska Asia Australia, New Zealand Canada Caribbean Central America China Continental US Eastern Europe Hawaii Mediterranean Mexico Middle East North America Pacific Rim Polar Regions Russia Scandinavia South America South Pacific Western Europe
I enjoy doing the following when on vacation (check all that apply)
	Art/Theater Ballooning Climbing Cycling Diving Extreme Sports Family Adventures Food/Wine Golf Hiking Indigenous Cultures Music Photo Treks Safari North America Sailing Sun/Sand Walking Water Sports Wildlife/Nature
	I dine on cuisine native to the vacation region
I prefer specific types of food while on vacation:

LEISURE TRAVEL SPECIFICS

Passport Information

Name on passport

Passport number

Expiration date

Citizenship

Place of issue

Issue date

Place of birth

Date of birth

Frequent flyer numbers

Airline	Account No	Status (if applicable)

My preferred Airline(s) are

I prefer the following airline seating (check all that apply)

Window seat
Aisle seat
first class only
Business class or above
Private Jet

Hotel Membership Numbers

Hotel Name	Membership Number

I prefer the following amenities (check all that apply)

Non-smoking
Smoking
Deluxe Room
Junior Suite
Penthouse Suite
King Bed Only
Butler Service
Lower Floor
Higher Floor
Water View (if applicable)
Hotel Pool
Private Pool
Exercise Facility

Rent a car preferences

Rent at airport
Rent at hotel
Hire private car/driver
Manual
Automatic

Car Membership Numbers

Car Firm	Membership Number

Luggage handling

I always carry my luggage with me
I use the following luggage service

I would like to use a luggage service in the future

Travel Insurance

I require travel insurance for each vacation

I would like to have travel insurance for future vacation
I don't require travel insurance

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Address:
1500 4th Street North
St. Petersburg, FL 33704

Phone:
727-896-7161

Fax:
727-896-7167

email:
info@hillstravel.com

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