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Hampton Travel Agent
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Hampton, VA
Hampton Travel Agent

LTS Profile

General Information
Travelers Name:
(Full given name it appears on your driver’s license or passport)
Birthdate:
  MM  DD  YYYY   (TSA REQUIRES YOUR BIRTHDATE)
E-mail:
Home E-mail:
Title:
Dept. Name & #:
Badge Number:
Project Number:
Company Name:
Company Address
Street:
City/State:
Zip:
Home Address
Street:
City/State:
Zip:
Business Phone:
 - -
Home Phone:
 - -
Travel Contact Name:
Credit Card
Business Travel
Credit Card Type:
Credit Card Number:
Name as it appears on Card:
Expiration Date:
Personal Travel
Credit Card Type:
Credit Card Number:
Name as it appears on Card:
Expiration Date:
Personal Credit Card Authorized Signature:
Billing Address
Street:
City/State:
Zip:
Frequent Flyer Membership
Please provide numbers for frequent flyer programs in which you hold membership(s). Note to ensure credit is received; the name on your frequent flyer accounts must match the name as it appears on your ticket.
American AAdvantage:
America West:
Air Tran:
Continental OnePass:
Delta Frequent Flyer:
US Airways:
JetBlue:
United:
Southwest Airline:
Other:
Other:
Other:
Preferences
Seating   (All domestic flights are non-smoking)
Domestic
Window:
Aisle:
Special Seating:
International
Smoking:
Nonsmoking:
Window:
Aisle:
Special Seating:
Special Meals
Bland:
Diabetic:
Kosher:
Low Calories:
Low:
Cholesterol:
Salt Free Vegetarian:
Other:
Special Service Request: (i.e., Wheelchair assistance, etc.)
Airline VIP Clubs
Please provide number for airline clubs in which you hold membership(s).
AA Admierals:
Continental Presidents:
United Red Carpet:
USAir:
Delta Crown Room:
Other:
Car Rental Clubs
Please provide number for car rental clubs in which you hold membership(s).
Alamo:
Dollar:
Avis Wizard:
Hertz:
Budget Super Res:
National Green Lite:
Other:
Other:
Car Preferences
2Door:
4Door:
Subcompact:
Compact:
Intermediate:
Luxury:
Minivan:
Other:
Hotel Clubs
Please provide numbers for hotel clubs in which you hold membership(s).
Hilton:
Marriott:
Holiday Inn:
Ramada:
Hyatt:
Sheraton:
Other:
Other:
Hotel Room Preferences
Single:
Double:
Queen:
King:
Smoking:
Nonsmoking:
Other:
International Travel Data
A VALID PASSPORT REQUIRED FOR INTERNATIONAL TRAVEL- Please ask about Visa requirements
Passport #:
Passport Expiration:
Name as Shown on Passport:

Date of Birth:
Citizenship:
Place of Issue:
Country of Residence:
Emergency Contact:
Airlines are required to collect contact information for all international flights)

 (Name & Telephone Number)
Please fill in the word below in the box: