UNIGLOBE Travel Innovations Ltd.
The personal information which we maintain and use is solely for the purposes of servicing the travel arrangements through Concur Travel Solutions or via a TIL Travel Consultant.
By submitting this form you duly authorize TIL Travel to continue to maintain and use your personal information which TIL Travel may already have access to and to use same in strict accordance with the Privacy Policy stated by TIL Travel. This form is SSL encrypted. updated 2018
  • PERSONAL INFORMATION

    Please provide your full legal name as it appears on your passport
  • i.e. Mr./Mrs./Ms./Dr. etc.
  • i.e. Jr./IV. etc.
  • DAY/MONTH/YEAR
  • DAY/MONTH/YEAR
  • DAY/MONTH/YEAR
  • - -
  • - -
  • TRAVEL PREFERENCES

  • AAdvantage
    Aeroplan
    MileagePlus
    Skymiles
    VIPorter
    Westjet Rewards
  • Please list the applicable hotel programs with number
  • Avis-Wizard Number
    Budget-Fastrak
    Hertz-Gold Club
    Enterprise Plus
    National-Emerald Club
  • PAYMENT INFORMATION

  • MONTH/YEAR
  • This is the 3 digit code on the back of your credit card
  • MONTH/YEAR
  • This is the 3 digit code on the back of your credit card