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PERSONAL DETAILS

Company name:

Department:

Surname:

* New Traveller Amended Details

First name and title:

* Initials: *

Home address:

Suburb: Postcode:

Home telephone number:

Mobile number:

E-mail address:

Position within the company/title:

Office location:

Secretary/Travel booker:

Name:

Direct telephone number:

E-mail address:

Individual card number for billing:(Please state if company card)

Cost centre (for travel reporting purposes - if remains static):

Project number (if remains static for passenger):

PASSPORT INFORMATION

Second Passport (if held):

Name on Passport:
Date of birth:
Nationality
Passport number:
Issue date:
Place of birth:
Expiry date:

Name on Passport:
Date of birth:
Nationality
Passport number:
Issue date:
Place of birth:
Expiry date:

FLIGHT BOOKINGS

Airline preferences:

Domestic:
International:

Avoid airlines:

Mileage memberships:

Airline:	Number:	Pin No:
Airline:	Number:	Pin No:
Airline:	Number:	Pin No:
Airline:	Number:	Pin No:
Airline:	Number:	Pin No:

Seating requirements:

Smoking Non-smoking
Window Aisle Other

Dietary requirements: e.g. Vegan/Kosher/Low salt

Medical requirements:e.g. Diabetic/wheelchair assistance

HOTEL BOOKINGS

Hotel preferences:

Domestic:
International:

Hotel chains to avoid:

Frequent Guest Cards:

Hotel: Number:
Hotel: Number:
Hotel: Number:

Preferred Room Type:

Single Double Twin Suite
Smoking room Non-smoking room

Hotel special requests:

Credit card number for guarantee:

Expiry date:

CAR HIRE

Car preferences:

Manual Automatic

Car hire companies to avoid:

Driving licence number:

Membership Cards:

Company Number
Company Number

ADDITIONAL INFORMATION

Interests e.g. rugby/theatre:

Partner's name:

Partner's mileage membership details:

INFORMATION PRIVACY

For the protection of your information please review our Privacy Statement.

I give consent to TRAVELOG!C to provide the abovementioned information to other parties for the purpose of booking travel.

I do not give consent to TRAVELOG!C to provide the abovementioned information to other parties for the purpose of booking travel.

GENERAL REMARKS

MARKETING INFORMATION

What percentage of travel do you complete in a year to the following destinations:-

UK	%	USA	%
Europe	%	Asia	%
New Zealand	%	Other International	%

Do you use a laptop when travelling?

Yes No

Is it important that you are contactable when overseas? Yes No

Are you interested in receiving information on TRAVELOG!C special promotions on any of the following?

Flights Hotels Car Hire Conferences Holidays Travel Related Products

Date of Completion:

Completed By:

Please do not send sensitive personal or confidential information (e.g. account numbers) via e-mail as a secure e-mail protocol is not being used

Select your Travel Specialist: *

C.C

C.C. Expiry Date