Traveland - Customer Preferences Form

Please Fax this form to: 203-372-2556

First Name:      
Middle Name    
Last Name:      
Name must match the passanger form of ID prented at time of check-in
Date of Birth:      
Company Name:    
Address 1: Address 2  
City: State:  
Zip: Country:  
Day Phone: Cell Phone:  
Home Phone:    
Passport Number: Passport
Exp. Day:
Airlines & Flight Preferences
Seat Preference      
Special Meal:      
Frequent Flyer Programs  
American: United:  
Continental: Other Airline:  
Delta: Other Airline  
Northwest: Other Airline:  
Us Air:    
Car rental preferences  
Car Size Pref: Other Car1:  
Alamo: Other Car2:  
Avis: Other Car3:  
Hotel preferences
Hotel Room Pref: Radisson:  
Hilton: Sheraton:  
HolidayInn: Other Hotel1:  
Hyatt: Other Hotel2:  
Marriott: Other Hotel3: