Central Travel

Traveler Profile Form

PERSONAL INFORMATION:

First Name:

Last Name:

Address:

City:

State:

Zip:

Country:

I would like to receive vacation offers via:

Phone Number:

Mobile Number:

Fax Number:

Email Address:

Age Range:

Gender:

Status:

If married:

Spouse/significant other name:

Anniversary:

PAST LEISURE TRAVEL INFORMATION

Frequency of Leisure Travel:

Average length of leasure vacation:

Average Budget per person, per leisure vacation:

LEISURE TRAVEL PREFERENCES

I prefer or would like more information about (check all that apply)

Cruising

Escorted Tours

Lodging

I have traveled to or would like more information about (check all that apply):

I enjoy doing the following when on vacation (check all that apply)

I prefer specific types of food while on vacation:

LEISURE TRAVEL SPECIFICS

Passport Information

Name on passport:

Passport number:

Expiration date:

Citizenship:

Place of issue:

Issue date:

Place of birth:

Date of birth:

Frequent flyer numbers

Airline	Account No	Status (if applicable)

My preferred Airline(s) are:

I prefer the following airline seating (check all that apply:

Hotel Membership Numbers

Hotel Namep	Membership Number

I prefer the following amenities (check all that apply)

Rent a car preferences

Car Membership Numbers

Car Firm	Membership Number

Luggage handling

I always carry my luggage with me
I would like to use a luggage service in the future
I use the following luggage service

Travel Insurance

I require travel insurance for each vacation
I would like to have travel insurance for future vacation
I don't require travel insurance

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