When you contact us for the first time, feel free to fill in or leave blank any part of the following forms except for the method you'd like us to use in contacting you. If needed, you may also reach us by email at:

 ConciergeContact@aol.com

To protect your privacy, ConciergeContact will only register your information once you have contracted our services.

 
Please fill out the following form so that
we can begin serving you:

 First & Last Name

Title

Street Address

Address 2 (if any)

City

State or Province

Zip or Postal Code

Country

Work Phone

Home Phone

FAX

E-mail Address

E-mail allows us to contact you almost immediately. Please check the applicable statement below:

You may E-mail me as soon as possible.

I would prefer that you contact me in another way. 

If you prefer a method of contact other than E-mail, please indicate your preference below. Be sure to include the best time of day for us to contact you. [Example: Please call me at my home number above after 6 PM.]:

 

Please check the appropriate statements:

I would like you to arrange my hotel reservations.

I wish to reserve your Custom Itinerary service.

I do not wish to reserve your service at this time. 
      Please see my comments/questions below.

If you know the dates you will be travelling, please provide them in the following entry box:

 

Please use the entry box below for any comments, questions, or additional information that you would like to provide:

 

Click the 'Send Information' button only once, then wait for the next page acknowledging your information.

 

 Thank you! Of course the information you send us will always be kept confidential.