Travel Leaders/Atlantic Pacific Travel

Travel Leaders/Atlantic Pacific Online Reservation Request Form

Complete the information below to have your request electronically submitted to Travel Leaders/Atlantic Pacific Travel. Travel Leaders /Atlantic Pacific Travel will contact you to confirm receipt of your request.

For routine travel requests, you should receive a message within 2 hours that the agency received your request. Within 24 hours you are to receive a message confirming your requested itinerary or your requested options.

Remember this form is only a request and not a confirmed reservation until you receive a confirmation number from Travel Leaders/Atlantic Pacific

TRAVELER INFORMATION

First name:

Last name:

E-mail address of contact:

Phone number:

Department Number:

Please select what type of transaction this will be:

**for changes or cancellations, please indicate original departure date and traveler name:

Special preferences will be requested based on your travel profile. If incomplete or no profile exists, please update your traveler profile.

CONTACT INFORMATION (if different from above)

First name of contact:
Last name of contact:
E-mail address of contact:
Phone number:
Fax number:

DELIVERY INFORMATION (if applicable)

Physical Address:

Line 1:

Line2:

Line3:

City:

State:

Zip:

AIRLINE TRAVEL ARRANGEMENTS

Departure city and state:

Arrival city and state:

Departure city and state:(if different

Departure date:

Approximate time OR flight number of departure:

Return date:

Approximate time OR flight number of return:

Use Remarks block for multiple city's:

Remarks:

CAR RENTAL ARRANGEMENTS

Car rental company:

Car type / size:

Special requests:

HOTEL ACCOMMODATIONS

Preferred hotel:

Alternate hotel:

Check-in date:

Check-out date:

***if credit card number is not included in your current Travel Leaders/Atlantic Pacific Travel Traveler Profile, an agent will contact you via phone for a valid number

Room type:

Size of bed:

Special requests:

If you would like a printed version of this page with what you entered in, don't forget to print before you click submit.