Name (First & Last)*

Phone number*

Your email*

How would you like to be contacted?

Call

Text

Preferred Setup Date & Time*

Event Location Type*

Hotel

Airbnb

Private Residence

Other

Hotel/Airbnb Name (if applicable) Please note: Client is responsible for obtaining hotel or Airbnb permission for room decor.

Select Your Valentine's Package*

Classic Valentine Experience - $399

Luxe Valentine Experience - $655

How will we gain access to room?*

I will leave name with front desk and have them leave a key for entry

We can meet up somewhere

If this is an Airbnb, please provide code the day before event for smooth entry

Please provide the name your reservation is under so we can confirm access upon arrival

Desired color(s) (red, green, etc)*

Would you like for us to come the next morning and clean? *Cleanup times: Saturday & Sunday: 8am - 10:30am (early morning before checkout). Requires a plan of re-entry. Reduced travel fee will apply.

Yes please! (cleanup fee apply depending on package $85 - $150)

No thanks!

What would you like to say to your special someone? (Your Love Note)

Are you eligible for our 10% Hero Appreciation Discount? This discount is for our First Responders, Military, Educators, Healthcare Workers & Law Enforcement (including Corrections) We will verify through contract*

Yes - I qualify personally

Yes - This is a surprise for my spouse/parent/child who qualifies

No - I do not qualify

Will you be using Book Now, Pay Later option?*

Yes

No

If Yes, Which platform?

Klarna

Afterpay

Zip

How did you hear about us?*

Additional Requests, Add-Ons or Questions... If you have any inspiration photos please email us at signaturespecialmoments@gmail.com once you have submitted your form

Travel Acknowledgement (IMPORTANT)*

I understand that pricing includes service withing 15 miles of Hinesville, GA and that additional travel and parking fees may apply for locations outside this area, including Savannah, Pooler, Brunswick and surrounding area.

Booking Agreement Acknowledgement*

I understand that a non-refundable retainer is required to secure my booking.

I understand that Valentine's Day bookings are first come, first served.

I understand that remaining balance must be paid 72 hours before event date.

Valentine's Day Booking Request Form

Note for Travel, Parking & Book Now, Pay Later Options

Travel fees are added based on the distance from Hinesville, GA. Final travel cost will be confirmed after the location has been verified. If your location is over 60 miles, we will send your custom invoice after calculating mileage.

If parking or valet fees apply, the cost will be charged to your hotel room ( if available) or added to your final balance. Please make sure the front desk has Signature Special Moments listed for access to your room for setup.

Book Now, Pay Later Options

Please ensure you already have an account with Klarna, Afterpay, or Zip and are pre-approved before booking. We recommend signing up in advance to know your spending limit and eligibility.

Please read all package details and FAQs and Our Policy before filling out this form.

We can't wait to bring your Signature Special Moment to life!

Valentine's Day Booking Request Form

Note for Travel, Parking & Book Now, Pay Later Options

Lets Make Your Special Moment

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