DESIGN YOUR OWN TOUR / TAILER-MADE-FORM
Contact Information
Title:
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* Country of Residence:
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Travel Itinerary Information
For which destination
would you like to request further information? (if you are
considering several destination for your travel plans, please inquire in
the destination you believe is the lead destination)
Please choose the main destination
Phnom Penh Siem Reap
Sihanouk Ville Preah Vihear
If you are interested in visiting more
than one destination,
please tick the appropriate country:
Travel Period
I would like to travel for:
Please select duration
Less than 3 days
3 to 7 days
8 to 10 days
11 to 15 days
More than 15 days
Not sure
I know the exact dates of my holidays and I want to
travel:
From:
Day 1
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
/
Month
January
February
March
April
May
June
July
August
September
October
November
December
/
Year 2008 2009 2010 2011 2012
To:
Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
/
Month January February March April
May June
July August September October November December
/
Year
2008 2009
2010 2011
2012
I am unsure but probably in
Month January February March
April May
June July
August September October November
December
/
Year 2008 2009 2010 2011 2012
Tour Style & Details
What kind of tour are you looking for?
Select a tour type Tailor-Made Touring
Itinerary Beach Holiday
Hotel Booking only Flight Booking only Other
My interests are (please let us know on a
scale of 1-5 the level of interest you have in each category. 1 = no
interest / 5 = high interest)
Select 1
2 3 4 5
Real Adventure
Select 1
2 3 4 5
Soft Adventure
Select 1
2 3 4 5
Culture (Temples, Archaeological, Heritage sites)
Select 1
2 3 4 5
Culture (meeting and learning about local people and
customs)
Select 1 2 3 4 5
Golf
Select 1 2 3 4 5
Spa / Wellness
Select 1
2 3 4 5
Shopping
Select 1
2 3 4 5
Cooking Classes
Select 1
2 3 4 5
Cruises
Please, use the box below to give
us as much detail as possible about your tour.
If you have a route in
mind, please let us know. Please, add any information you
would like to
include, such as special requirements, must-see places, pace or
timing
of
your journey, etc.
Hotel Information
I prefer you to organize my trip with a majority of:
Standard hotels
First-class hotels Superior hotels Deluxe hotels
I would like you to organize my trip on a:
Room and
breakfast basis Half board
basis Full board
basis
Almost done...
Do you already have your international flight tickets? Yes No
Do you require any airline assistance for your international flights?
Yes No
How many adults
will be travelling?
Please select 1 2 3 4
5 More than
5
How many infant(s) below two years will be
travelling?
Please select 1 2 3 4
5 More than
5
How many child/children will be
travelling? Please select 1 2 3 4
5 More than
5
The group is:
Please
select An individual
traveller A couple A family A group of
friends Other
If other, please specify:
How did you hear about
us?
Please select
I am already a client of Heritic Asia
My local newspaper
My community magazine
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I have been recommended by a friend
Google Altavista Yahoo!
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Other
If other, please specify:
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