Fox Valley Travel - 2595 S. George St., York, PA 17403 - Phone 717.741.5066 - Tollfree 800.288.5066 - Fax 717.741.9150 - E-Mail Us  


Personal Profile Form

Please complete the following form as fully as possible so that we may assist you. 
When we receive your information, we will be in touch soon 
to discuss your needs and your options.  
Questions?  Please feel free to contact us by phone or e-mail.

Date:
Account Rep:

Name:

Employee ID #

Title:

Company Name:

Business Address:

City:
 State:
 ZipCode:

Business Phone Number (with Area Code):

Business Fax Number (with Area Code):

Cellular Phone Number (with Area Code):

Secretary's Name

Secretary's Phone Number (with Area Code):

Home Address:

City:
 State:
 ZipCode:

Home Phone Number (with Area Code):

E-Mail Address:

PERSONAL PREFERENCES (Company policy takes precedence over personal preferences)

Airline

1

2

3

Special Meal Requirements

Seating  Smoking   Non Smoking   Window   Aisle   Other

If other

Frequent Flyer Member

American
 Southwest
 Delta
Continental
 Northwest
 US Airways
United
 AirTran
 Other

Car Company

1.

2.

3.

Size:   Compact   Midsize   Full Size 2 door   Other

If other

Avis Wizard #
 Nat'l Emerald Club
 Hertz #1 Club
Budget Express#
 Other
 Other

Hotel Chain

1.

2.

3.

Room Type:   Single   Double   Suite    Other

If other

Smoking    Non Smoking

Holiday Inn Priority #
 Hilton Honor#
Marriott#
 Ramada Business Club#
Hyatt Gold Passport#
 Sheraton Club International
Other (Name/Number)

 		 Other (Name/Number)

 
INTERNATIONAL TRAVEL DATA
Passport Number
 Expiration Date
Citizenship
 Visas Held

PERSONAL
Spouses Name
Seating  Smoking   Non Smoking   Window   Aisle   Other

If other

Emergency Contact
Work Telephone (with Area Code)
 Home Telephone (with Area Code)
 
Fox Valley Travel Agency would like to update you on special travel packages as they become available. Please check any areas of special interest.

Cruises   Sun Spots   Europe   Sports Tours   Pacific  
Motorcoach   Other


BILLING INFORMATION
Business Travel

Credit Card

Credit Card Name
Card No
 Exp Date
Bill to Company

For hotel guarantees and car rental use:

Credit Card Name
Card No
 Exp Date

Personal Travel

I hereby authorize FOX VALLEY TRAVEL to charge any transactions requested to the following credit card:

Credit Card Name
Card No
 Exp Date

Please note any other services you require as well as any other information that will assist us in planning your services (including unique or special travel/accommodation needs):