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1. PREFERRED CLIENT INFORMATION
Send to:
For
security and verification reasons, we will not collect
credit card information on this form.
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Passenger
Name:
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MR.
MS.
MRS. |
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(last,
first, middle initial)
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Title:
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Company
Name:
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Street
Address:
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City:
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State:
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Zip Code:
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Office
Telephone:
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Ext:
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Office
FAX:
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Office
Email:
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Department
Name:
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Department
#:
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Employee #:
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Ticket
Delivery Location:
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Assistant's
Name:
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Assistant Phone:
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Ext:
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Passenger's
Home Address:
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City:
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State:
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Zip Code:
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Home
Telephone:
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Cell
Phone:
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Emergency
Contact Phone Number:
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2.
PERSONAL PREFERENCES
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I
am authorized to fly:
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Coach
First Class
Business
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International
(specify):
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Special Services Required?
No
Yes (specify):
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Seating
Preference:
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Smoking
Non-Smoking
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Aisle
Window
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3.
CAR RENTAL PREFERENCE OF YOUR COMPANY
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Avis Wizard
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#:
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Hertz Number
1
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#:
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Budget
Express
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#:
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National Emerald
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#:
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Other (specify):
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#:
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Economy
Compact
Intermediate
Standard
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Luxury Other (specify):
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4.
HOTEL PREFERENCE OF YOUR COMPANY
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Starwood
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#:
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Hilton
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#:
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Marriott
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#:
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Holiday Inn
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#:
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Radisson
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#:
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Other (specify):
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#
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Other (specify):
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#
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Other (specify):
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#
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Many
of our travelers have definite hotel preferences in certain
cities. If you wish, please list yours below.
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City:
Hotel:
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City:
Hotel:
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City:
Hotel:
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| 5.
HEALTH / DIET REQUIREMENTS |
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Diabetic
Low Calorie
Low Cholesterol
Salt Free
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Vegetarian Other:
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| 6.
FREQUENT FLYER INFORMATION |
| Please
note frequent flyer status with each airline, i.e., Platinum,
Gold, Medallion, etc. |
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Delta
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#:
Status
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Continental
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#:
Status
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American
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#:
Status
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US Air
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#:
Status
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Southwest
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#:
Status
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JetBlue
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#:
Status
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United
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#:
Status
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Air Canada
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#:
Status
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Virgin
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#:
Status
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Airline:
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FF#:
Status:
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Airline:
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FF#:
Status:
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Airline:
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FF#:
Status:
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Airline
Preference:
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Senior
citizen discount applies
(62 and over)?
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Yes
No |
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A.A.R.P.
#
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A.A.A.
#
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| 7.
INTERNATIONAL TRAVEL INFORMATION |
| Visas
Currently Held: |
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Country:
Exp. Date
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Country:
Exp. Date
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Country:
Exp. Date
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Citizen
of:
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Country:
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Place
of Birth:
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Date
of Birth:
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Passport
#:
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Passport
Exp. Date:
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| 8.
LEISURE TRAVEL |
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Yes, I would like to be on your leisure travel mailing list!
Enter
email address to use:
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