Travel Request Form
TravelActive.com
 
 

Traveller Name:

  

 
 

Company Name:

  

 
 

E-mail Address:

  

 
 
 

Departure City / Airport:

    
 

Alternate Departure City / Airport:

    
 
 

Arrival City / Airport:

    
 

Alternate Arrival City / Airport:

    
 
 

Departure Date:

    
 

Flexible:

Yes

No

   
 

Earlier

Later

   
 
 

Departure Time:

    
 

Flexible:

Yes

No

   
 

Earlier

Later

   
 
 

Return Date:

    
 

Flexible:

Yes

No

   
 

Earlier

Later

   
 
 

Return Time:

    
 

Flexible:

Yes

No

   
 

Earlier

Later

   
 
  Airfare Requirement:

Full Fare

  

Flexible Excursion Fare

  
   

Lowest Fare

  

Lowest Fare Incl. Consolidator

  

 

Travel Insurance Requirements

  
 

Cancellation Insurance:

Accept

Decline

   
 

Out of Country Health/Medical:

Accept

Decline

   

 
 

Hotel Required:

Yes

No

   
 

Preference (Hotel name / chain or zip code):

    
 

Special Rates If Applicable (i.e. customer rate / gov't rate):

    
 
 

Car Rental Required:

Yes

No

   
 

Preferred Company:

    
 
 

Airport Transportation Required:

Yes

No

   
 

Preferred Company:

    
 

Special Notes
Please let us know if you have any further requests or comments:

 

   


PLEASE NOTE

Fares are subject to availability and change. Fares are not guaranteed until booked and ticketed. Requests submitted through this form will only be processed from 8:30 am to 5:30 pm Monday to Friday. Requests received after 5 pm will be processed the next business day. Mills Travel is not responsible for any delay in response time due to server problems.