TRAVEL PROFILE

TRAVELER PROFILE – Confidential
Last Name:
First Name:
Middle Initial:
Company Name:
Title:
Cost Center #/Dept#/Employee #:
Street Address:
City/State/Zip Code:
Business Phone / ext :
Fax:
Email Address:
Home Phone:
Cell Phone:
Date of Birth/Gender:
Home Address:
City/State/Zip Code:
Home E-Mail:
Point of Origin (Airport/City you fly from):

FREQUENT FLYER MEMBERSHIP / NUMBERS (1)

AIRLINE:
NUMBER:
PIN CODE:
NAME ON CARD:
STATUS:
SEAT PREFERENCE:
SPECIAL MEALS:
(PLEASE SPECIFY)

 

FREQUENT FLYER MEMBERSHIP / NUMBERS (2)
AIRLINE:
NUMBER:
PIN CODE:
NAME ON CARD:
STATUS:
SEAT PREFERENCE:
SPECIAL MEALS:
(PLEASE SPECIFY)

 

FREQUENT FLYER MEMBERSHIP / NUMBERS (3)
AIRLINE:
NUMBER:
PIN CODE:
NAME ON CARD:
STATUS:
SEAT PREFERENCE:
SPECIAL MEALS:
(PLEASE SPECIFY)

CAR RENTAL CLUB MEMBERSHIP / NUMBERS (1)
(attach a separate sheet if needed)
RENTAL AGENCY:
NUMBER:
NAME ON CARD:
STATUS:
CAR SIZE / SPECIAL REQUEST:

 

CAR RENTAL CLUB MEMBERSHIP / NUMBERS (2)
(attach a separate sheet if needed)
RENTAL AGENCY:
NUMBER:
NAME ON CARD:
STATUS:
CAR SIZE / SPECIAL REQUEST:

 

CAR RENTAL CLUB MEMBERSHIP / NUMBERS (3)
(attach a separate sheet if needed)
RENTAL AGENCY:
NUMBER:
NAME ON CARD:
STATUS:
CAR SIZE / SPECIAL REQUEST:

HOTEL CLUB MEMBERSHIP (1)
(attach a separate sheet if needed)
HOTEL NAME:
NUMBER:
NAME ON CARD:
STATUS:
ROOM TYPE PREFERENCE:
CREDIT CARD FOR HOTEL GUARANTEE:
NUMBER:
NAME ON CARD:
CID and Expiration:
I hereby authorize Lagniappe Travel Services to charge my card any travel transactions made by my authorized agent at Lagniappe Travel Services. These transactions may be made by telephone, letter, fax, or email until further notice.
Agree
Disagree


HOTEL CLUB MEMBERSHIP (2)
(attach a separate sheet if needed)
HOTEL NAME:
NUMBER:
NAME ON CARD:
STATUS:
ROOM TYPE PREFERENCE:


HOTEL CLUB MEMBERSHIP (3)
(attach a separate sheet if needed)
HOTEL NAME:
NUMBER:
NAME ON CARD:
STATUS:
ROOM TYPE PREFERENCE:


PASSPORT INFORMATION (1)

PASSPORT NUMBER:
EXPIRATION DATE:
ISSUE DATE:
CITY OF ISSUAANCE:
IF NOT U.S. CITIZEN, RESIDENCE STATUS:
EXPIRATION DATE:
DATE OF BIRTH:

 

PASSPORT INFORMATION (2)

PASSPORT NUMBER:
EXPIRATION DATE:
ISSUE DATE:
CITY OF ISSUAANCE:
IF NOT U.S. CITIZEN, RESIDENCE STATUS:
EXPIRATION DATE:
DATE OF BIRTH:


PASSPORT INFORMATION (3)
PASSPORT NUMBER:
EXPIRATION DATE:
ISSUE DATE:
CITY OF ISSUAANCE:
IF NOT U.S. CITIZEN, RESIDENCE STATUS:
EXPIRATION DATE:
DATE OF BIRTH:

PERSONAL INFORMATION
Personal credit card #:
 YES
NO
CC Number:
Expiration Date:
Spouse’s Name:
Home Fax Number:
I would like to receive information regarding latest vacation travel / promotions:
YES
NO
Emergency Contact Name:
Telephone Number:
SPOUSE'S INFORMATION