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Passenger (We will issue tickets in the name you provide. Please enter it exactly as it appears on your government issued photo ID.)
Provision of Email Address is MANDATORY as this will be the avenue used to deliver intineraries/invoices and etickets.
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| First Name: |
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Title: |
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| Middle Initial |
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| Last Name |
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| *Please enter name EXACTLY as it appears on your government issued photo ID |
| Company: |
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Assistant: |
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| Business Address: |
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City: |
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| Postal Code: |
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Business Phone: |
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| Fax: |
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Cell Phone: |
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| Email: |
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Home Address: |
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| City: |
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Postal Code: |
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| Home Phone: |
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Date of Birth (D/M/Y): |
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| Passport #: |
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Country of Issue: |
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| Expiry Date: |
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Citizenship: |
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Next of Kin
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| Surname: |
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First Name: |
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| Initial: |
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Relationship: |
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| Business Phone: |
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Home Phone: |
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Billing Information
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| Department/Account/P.O. #/Employee #: |
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| Credit Card number (for ticket billing): |
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Personal Credit Card number
(to guarantee hotels if different): |
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| Copy of Invoice to be sent to: |
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Fax #/Email address: |
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Frequent Flyer Membership Numbers
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| Aeroplan: |
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Other: |
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| Delta Skymiles: |
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Other: |
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| Westjet #: |
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Other: |
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Important Note: In order to receive credit for Frequent Flyer Points it is imperative that your name is registered exactly the same for all programs on this profile.
Professional Association Membership Numbers where applicable
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| CPSA: |
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Other: |
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| NWCTA: |
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Other: |
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| CAA: |
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Other: |
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Airline Preferences & Special Needs
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| Seating: |
Aisle |
Window |
Bulkhead |
Special Meal Requests
(e.g. vegetarian, salt-free, etc.): |
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| Special Needs (e.g. wheelchair, etc.): |
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Car Rental Preferences
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| Company: |
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Car Type: Compact Mid size Full size |
| Membership Numbers: |
| Budget ID # |
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Avis ID # |
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| Hertz ID # |
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National ID # |
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| Other |
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Other |
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Hotel Memberships & Preferences
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| Hotel Company: |
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ID#: |
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| Hotel Company: |
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ID#: |
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| Hotel Company: |
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ID#: |
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| Hotel Company: |
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ID#: |
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| Special Requests: (e.g. non-smoking, king bed, feather pillows etc.) |
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| City: |
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Hotel Company: |
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| City: |
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Hotel Company: |
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| City: |
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Hotel Company: |
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| City: |
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Hotel Company: |
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Additional Requests & Comments
I hereby authorize Continental Travel Group to maintain and use the data provided above and to charge the credit card(s) specified above for the purpose of making and/or guaranteeing reservations as requested by me or my Travel Arranger. Continental Travel Group's Privacy Protection Policy can be found at www.ctgtravel.com |
| Signature |
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Date: |
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