Designer Travel Profile
Mail to - Designer Travel, Inc. • 13245 Riverside Drive, Suite 560, Sherman Oaks, Ca. 91423
Or Fax to (818) 789-5249

BUSINESS INFORMATION

Last Name: ________________________First Name: ________________________ Middle _______
Date of Birth (MM/DD/YYYY): __________________________ (Mandatory with new TSA regulations)
Title: _______________________________
Company: _______________________________ Street Address: __________________________
City: _______________________________ State: ______ Zip Code: _________
Telephone: _______________________________ FAX: _____________________________
E-mail: _______________________________ Cell Phone: ___________________________
Telephone # of Arranger/secretary: _______________________________
CAR RENTAL
Car Co. ______________ID# _____________Car Co. _____________ ID# _____________
Car Co. ______________ID# _____________Car Co. _____________ ID# _____________
Special Requests ____________________________________________________________
HOTEL
Hotel ______________ID# _____________Hotel _____________ ID# _____________
Hotel ______________ID# _____________Hotel _____________ ID# _____________
Special preferences if available Non-Smoking Room Smoking Room
Other _________________________________________________________________________
AIRLINE
Special Meal Requests (Specify) ____________________________________________________
Frequent Flyer Club Membership(s)
Airline ______________ ID# _______________Airline ______________ID# ________________
Airline ______________ ID# _______________Airline ______________ID# ________________
PASSPORT
Do you have a passport? _______________________________
Yes No- Country of citizenship Passport Number ______________________________
Issuance Date ________________Exp. Date _________
PERSONAL INFORMATION
Street Address: _______________________ City: ________________State: ___ Zip Code:______
Home Telephone: _____________________ Cell Phone: _______________________________
FAX: _______________________________ E-mail: _______________________________

CREDIT CARD INFORMATION
Name of Cardholder_________________________________________________________
MasterCard __ Visa __ American Express __
Credit Card # _____________________________________ Exp. Date: _____________
AUTHORIZATION
The undersigned traveler and the company hereby authorizes Designer Travel, Inc. to charge to the Card Account
(through signature on file) as indicated on this form, any business travel transactions requested by the
undersigned traveler or his authorized agent via telephone or letter while the account is in effect. The individual
traveler hereby authorizes Designer Travel, Inc. to charge his Card Account (through signature on file) as indicated
on this form, any personal travel transactions requested by him or his authorized agent via telephone or letter.


__________________________________________________________________________
Signature of Traveler __________________________________________________Date