Please complete this form and fax it to Travel Consultants - (415) 558-8960

State Agency Name:  _________________________________________________

Department/Unit Name:  ___________________________________   Unit Number:  ________

Employee Name:  ______________________________________Emp. I.D. Number:  _______

Email Address:  _______________________    Home Phone:  (      )  _________________

Work Phone:  (        )  __________________   Fax:  (       )  ______________________

Airline Information:        Seat Preference:   ____Aisle     ____Window

            Frequent Flyer Number:    Airline: ______________     Number: ______________

                                                         Airline: ______________     Number: ______________

Rental Car Company Preference: ______________________________________     

Car Type:         ____Compact   ____Midsize     ____Full Size    ____Other: ____________

             Car Club Numbers:  

                      Car Company:  ____________________  I.D. Number: ______________

                     Car Company:  ____________________   I.D. Number:  _____________

Please note that for the most part, all airline tickets will be billed to a central billing number, however, when making hotel reservations for you, we will require your personal credit card number to guarantee your reservations.  This number will be used for hotel reservations only.

Card Type:  ____________Number:  ______________________    Exp. Date:  ____/____

Thank you for selecting Travel Consultants.  In addition to your state travel requirements, please keep us in mind when planning your personal and vacation needs.  Our professional staff is here, ready to assist you.