Travel Profile
Feel free to contact us with any questions at (631) 673-7930 or
info@cdtravelplanners.com
Please print this page and fax to (631) 673-2218 or mail to 49 Main St, Cold Spring Harbor, NY 11724
Company Information
Company Name:
Title:
Address:
Address2:
City:
State:
Zip:
Business Phone:
Fax:
Business Email:
Personal Information
Full Name:
As it appears on your government issued ID / Driver's License (Domestic travel)
Date of Birth:
(mm/dd/yyyy)
Address:
Address2:
City:
State:
Zip:
Home Phone:
Mobile:
Personal Email:
Passport Information
Full Name*:
*As it appears on your Passport (International travel)
Passport Number:
Date of Issuance:
(mm/dd/yyyy)
Date of Expiration:
(mm/dd/yyyy)
Place of Issuance:
Credit Card Information
*As it appears on your Credit Card
Full Name*:
Credit Card Number:
Expiration Date:
(mm/yyyy)
CC Code:
Address*:
Address2:
City:
State:
Zip:
This Credit Card can be used for:
Airline
Hotel
Both
Click here to add another Credit Card
Full Name*:
Credit Card Number:
Expiration Date:
(mm/yyyy)
CC Code:
Address*:
Address2:
City:
State:
Zip:
This Credit Card can be used for:
Airline
Hotel
Both
Airport Information
List your Frequent Flyer Numbers in order of Airline Preference:
Airline Name:
FF Number:
Airline Name:
FF Number:
Airline Name:
FF Number:
Airline Name:
FF Number:
Airline Name:
FF Number:
Seating Preference:
Window
Aisle
Hotel and Car Membership Information
Hotel/Car Name:
Number:
Hotel/Car Name:
Number:
Hotel/Car Name:
Number:
Hotel/Car Name:
Number:
Hotel/Car Name:
Number:
Hotel/Car Name:
Number:
Special Requests
Authorization
I authorize C.D. Travel Planners, Inc. to charge my submitted credit card(s) for travel transactions requested by me or my authorized representative(s).