These are the details that will need to be submitted to Uplift through me as in independent agent. They will be entered into Uplift’s database and Uplift will send you a link to enter additional personal details. If for any reason you do not feel comfortable putting your information into this form, please feel free to go to Uplift’s site directly to see if you qualify for financing at www.uplift.com

Please complete the form below

PLEASE BE AWARE, FUNDS FOR APPROVALS WILL ONLY COVER A TRIP YOU HAVE WITH HEAL. TRAVEL. REPEAT. (CANDACE BLAIR’S TRAVEL GROUP) GO TO UPLIFT.COM IF YOU WOULD LIKE TO APPLY FOR A TRIP ELSEWHERE.

Name *

First Name

Last Name

Email *

Phone *

Please enter a number that can receive texts. For "Country" enter the number before your area code for your country.

Country

(###)

###

####

Country *

What country are you from?

USA

Canada

Other

Trip Details *

Please select all parts of your trip you need help with financing.

Cruise (add cruise line below if a cruise)

Package (hotel, flight, car or any combo in one package)

Flight

Lodging (hotel/Airbnb)

Travel Insurance

Rental Car

Add-ons (additional costs added to trip)

Cruise additional info

If you need help with a cruise, what cruise line and what ship on the cruise line is it?

Amount to be Financed *

Please enter how much you need to finance. It must be at least $150.00 USD and no more than $15,000.00 USD

Trip Duration *

Please enter the dates of your trip in MM/DD/YYYY format

Number of Traveler's *

Please enter the number of travelers

Is the borrower traveling on the reservation? *

Yes

Send Link *

How would you like the link to enter your personal details to finish the application sent to you?

Text

Thank you! The link to finish your application will be sent via your preferred method within 24 hours.