Designer Travel Group Profile

Project Name: ___________________________________________

Last Name: _________________________First Name: ____________________________ Middle:_______________

Date of Birth (MM/DD/YYYY) ________________________:
Title: _______________________________
Company: _______________________________ Street Address: ____________________________
City: _______________________________ State: ______ Zip Code: _________
Telephone: _______________________________ FAX: _____________________________
E-mail: _______________________________ Cell Phone: _____________________________

Special Requests







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 Cardholder--------------------------------------------------------------------Date


_________________________________________________________________________
Signature of Authorized Agent, if any (for example: secretary, travel coordinator) ---------Date

Mail to - Designer Travel, Inc.
13245 Riverside Drive, Suite 560, Sherman Oaks, Ca. 91423

Or Fax to - (818) 789-5249

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