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Hampton Travel Agent
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By appointment Please call 757.723.0701 for appointments or email lawtons@verizon.net | Hampton, VA
Hampton Travel Agent

LTS Profile


General Information
Travelers Name:

(Full given name it appears on your driverís 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: