Impact Traveler Profile

Traveler Profile

PLEASE ENTER YOUR NAME EXACTLY AS IT APPEARS ON YOUR GOVERNMENT ISSUED PASSPORT.

* Indicates required field

Name*

First Middle Last

Company Name

Title

Division/Dept.

Cost Center

Office Location

Employee ID #

Birth Date (MM/DD/YYYY)*

Email*

Gender*

Male
Female
Other

Phone with country code

Office Phone with country code

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Traveler Passport Information

Passport Number

Citizenship

Country of Issue

Expiration Date (MM/DD/YYYY)

Preferred Hometown Airport

Alternate Airport

Credit Card Information

***For security purposes, please call our offices to provide any credit card information.

Emergency Information

Emergency Contact Name

First Last

Emergency Contact Phone

Comments

Frequent Flyer Information

*Please make sure all frequent flyer account numbers match government issued photo ID.

American ID #

Delta ID #

United ID #

Other Airline Loyalty Numbers

TSA Pre-check

TSA Pre-check #

Airline Seating Preferences

First Choice

Front of Plane
Back of Plane

First Choice

Aisle
Window

Second Choice

Front of Plane
Back of Plane

Second Choice

Aisle
Window

Special Meal Requests

Special Meal/Dietary Requests (if necessary)

Hotel Loyalty

Example: Marriott/123456

Hotel Chain 1/ Loyalty Number

Hotel Chain 2/ Loyalty Number

Hotel Chain 3/ Loyalty Number

Hotel Chain 4/ Loyalty Number

Hotel Room Preferences

Smoking
Non-smoking
No Preference

Car Rental Memberships

Example: Hertz/123456

Hertz ID #

Avis ID #

National ID #

Alamo ID #

Other Car Loyalty Numbers

Car Rental Preferences

Compact
Standard
Mid-sized
Luxury

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Number

Impact.com Traveler Profile