Personal Information Form Frett Cooper - Allied Travel

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Personal Information Form Frett Cooper
Full legal name EXACTLY as it appears on your passport or passport application
1. _____________________________________________________________________________
Gender M F
Date of birth ________________
Passport #____________________________ Passport Expiration__________________________
2. ______________________________________________________________________________
Gender M F
Date of birth ________________
Passport #____________________________ Passport Expiration __________________________
Note: passports are not required to make a reservation, but they ARE required for international travel!
They must be valid for AT LEAST 6 months beyond your trip return date.
Home address: _______________________________________________________________________
City____________________________________________State___________________Zip___________
Home phone: ___________________________________
Cell phone Name 1_______________________________ Name 2_______________________________
Email address Name 1 ____________________________ Name 2_______________________________
Airline mileage number(s):
Name 1 _______________________________________ Name 2_______________________________
Air seating preferences: Window
Center
Aisle
Seated together
Aisles across
Credit card information (we recommend that you call with this rather than sending it via email)
Card number__________________________________________________exp _________ cid________
Signature____________________________________________________________________________
Is the above address your credit card billing address?_________________________________________
Insurance
Accept__________________
Decline_______________________
Rooming preferences
King bed ________________
2 Double beds _________________

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