PERSONALIZED SERVICES INTERNATIONAL, LLC
117 East State Street, Suite B, O’Fallon, Illinois 62269
E-mail:
Toll Free: 1-866-774-4077 - Toll Free Fax: 1-877-774-5177
Services and Information Request Form
Client(s):
Address:
City: State: Zip code:
Home Phone: Work Phone:
E-mail Address:
Please note: by providing an e-mail address and personal information, we assume you are consenting to being notified of our exciting deals and promotions via e-mail. Your email address will not be shared with additional companies. If you do not wish to be contacted by e-mail, do not provide your e-mail information.
Are you interested in a:
Honeymoon: ______Destination Wedding: ______
Family Reunion Planning:______Fundraising:______
Travel: ______Wholesale Products: ______
Custom Designed Products: ______Wedding Date:
Top 3 Destination Choices
/Budget
/Number of Nights
1)2)
3) / □ Under $2,500
□ $3,501 - $4,500
□ $5,501 - $6,500 / □ $2,501 - $3,500
□ $4,501 - $5,500
□ Over $6,500 / □ 5 & under
□ 6 - 8 nights
□ 9 & above
Comments:
Please let us know what is your minimal: $______and maximal:$______budget
INDIVIDUAL BOOK FORM
QUESTIONAIRE
Traveler/Client(s) Full Name:
Address:
City: State: Zip code:
Home Phone: Work: ______
Date of Birth (MMDDYYYY): Number of Hotels Rooms/Cabins required______
E-mail Address:
Passport Number______Expiration Date:______
Special Accommodations: ______
Requested Airline or Hotel: ______
Traveler/Client(s) Full Name:
Address:
City: State: Zip code:
Home Phone: Work: ______
Date of Birth (MMDDYYYY): Number of Hotels Rooms/Cabins required______
E-mail Address:
Passport Number______Expiration Date:______
Special Accommodations: ______
Requested Airline or Hotel: ______
INDIVIDUAL BOOK FORM
QUESTIONAIRE
Traveler/Client(s) Full Name:
Address:
City: State: Zip code:
Home Phone: Work: ______
Date of Birth (MMDDYYYY): Number of Hotels Rooms/Cabins required______
E-mail Address:
Passport Number______Expiration Date:______
Special Accommodations: ______
Requested Airline or Hotel: ______
Traveler/Client(s) Full Name:
Address:
City: State: Zip code:
Home Phone: Work: ______
Date of Birth (MMDDYYYY): Number of Hotels Rooms/Cabins required______
E-mail Address:
Passport Number______Expiration Date:______
Special Accommodations: ______
Requested Airline or Hotel: ______