[Travel Agency]

Travel Request Form	Fax to: [fax number]

Personal and Billing Information
Traveler name
E-mail
Department
Phone
Fax
Delivery address
Billing address
Credit card name
Credit card number
Credit card expiration date
Travel Information
Destination
Departure date
Preferred departure time (e.g., morning, mid-day, evening)
Return date
Preferred return time (e.g., morning, mid-day, evening)
Seating preference (e.g., aisle, window, center)
Meal preference
Frequent flyer program name(s) and number(s)
Rental car program name(s) and number(s)
Rental car preference (e.g., compact, mid-size, luxury)
Lodging Information
Hotel program name(s) and number(s)
Room preference (e.g., king, double, single)
Smoking preference