travel preference data form

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Basic Information

Name (First, Middle Initial, Last): / /
Company Name:
Street Address / Floor/Suite: /
City / State / Zip: / /
Business Phone: ( )
Fax Phone: ( )
Home Phone: ( )
E-Mail address:
Home Address /Apartment Number: /
City / State / Zip: / /
Major cross street(s):
Name as to Appear on Tickets:
Employee ID# (If Required on Tickets/Invoices):
Travel Coordinator/Secretary Name:
Travel Coordinator/Secretary Phone Number: ( )
Travel Coordinator/Secretary E-Mail address:


Credit Card Information

I would like my business travel billed to : Number: Exp. / Type, If Other:
I would like my personal travel billed to : Number: Exp. / Type, If Other:
Additional Credit Card: Number: Exp. / Type, If Other:

Airport Preferences

Bay Area Airport You Prefer Using: 2nd Choice:
Normal Means of Getting to Bay Area Airport:


Airline Travel Preferences

Airline Preferences:
(list 5 in order of importance)		 Mileage #:
Mileage #:
Mileage #:
Mileage #:
Mileage #:
Domestic: First Class Business Class Economy Class
International: First Class Business Class Economy Class
Seat Preference: No Preference Window Aisle Smoking (International Only)
Special Meals:
(If vegetarian, please specify either lacto ovo or vegan)		 Fruit Plate Kosher Vegetarian Other


Car Rental Preferences

Rental Company:
(Please list 5 in order of preference)		 ID #:
ID #:
ID #:
ID #:
ID #:
Car Type Preference Economy Compact Mid-Size Full-Size Luxury Sport Other
Model / Make Preference
Do You Normally Take Optional CDW? Yes No
If so, With Which Credit Card?

Hotel Preferences

Hotel Chain Preferences:
(Please List in Order of Preference)
Membership #: Discount ID #:
Membership #: Discount ID #:
Membership #: Discount ID #:
Membership #: Discount ID #:
Membership #: Discount ID #:
Type of Accommodations:
Standard Deluxe Jr. Suite Suite Other
Smoking Room ?
Yes No
Do You Prefer That Your Hotel Booking be Guaranteed?
Yes No
If so, With Which Credit Card?

Passport Information

Country of Issue / Date of Issue: /
Date of Expiration / Place of Issue: /
Name As It Appears in Passport:

Visa Information

Country / Valid Thru: /
Country / Valid Thru: /

The above information will be kept on file and is considered confidential. The traveler and his/her company hereby authorize The Agency to arrange business travel requested by the traveler or his/her authorized agent via telephone, fax, e-mail or letter while the account is in effect, and charge the appropriate corporate or individual credit card, pursuant to company policy. The individual traveler hereby authorizes The Agency to charge his/her personal card account as indicated on this form for any personal travel transactions requested by the traveler or his/her authorized agent via telephone, fax, e-mail or letter. Submission of this form constitutes agreement to the terms above.

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