EmailMeForm
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
I have read the above disclaimer and consent to UNIGLOBE Travel Innovations Ltd. to use my personal information as described. Please click accept or decline. If you decline do not proceed filling out your personal data and contact us directly.
*
I accept
I decline
PERSONAL INFORMATION
Please provide your full legal name as it appears on your passport
Title
i.e. Mr./Mrs./Ms./Dr. etc.
Name
*
First
Last
Middle Name (if applicable)
Name Suffix (if applicable)
i.e. Jr./IV. etc.
Company Title
Gender
*
Male
Female
Date of Birth (D/M/Y)
*
DAY/MONTH/YEAR
Citizenship
*
Passport Number
*
Passport Expiry Date (D/M/Y)
*
DAY/MONTH/YEAR
Passport - Country of Issue
*
Additional Passport or Nexus Number
Additional Passport or Nexus Expiry Date
DAY/MONTH/YEAR
Home Address
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Aruba
Bahamas
Barbados
Belize
Canada
Cayman Islands
Cook Islands
Costa Rica
Cuba
Dominica
Dominican Republic
El Salvador
Grenada
Guatemala
Haiti
Honduras
Jamaica
Mexico
Netherlands Antilles
Nicaragua
Panama
Puerto Rico
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Trinidad and Tobago
United States
Argentina
Bolivia
Brazil
Chile
Colombia
Ecuador
Guyana
Paraguay
Peru
Suriname
Uruguay
Venezuela
Albania
Andorra
Armenia
Austria
Azerbaijan
Belarus
Belgium
Bosnia and Herzegovina
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Faroe Islands
Finland
France
Georgia
Germany
Greece
Hungary
Iceland
Ireland
Italy
Kosovo
Latvia
Liechtenstein
Lithuania
Luxembourg
Macedonia
Malta
Moldova
Monaco
Montenegro
Netherlands
Norway
Poland
Portugal
Romania
San Marino
Serbia
Slovakia
Slovenia
Spain
Sweden
Switzerland
Ukraine
United Kingdom
Vatican City
Afghanistan
Bahrain
Bangladesh
Bhutan
Brunei Darussalam
Myanmar
Cambodia
China
East Timor
Hong Kong
India
Indonesia
Iran
Iraq
Israel
Japan
Jordan
Kazakhstan
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Lebanon
Malaysia
Maldives
Mongolia
Nepal
Oman
Pakistan
Palestine
Philippines
Qatar
Russia
Saudi Arabia
Singapore
Sri Lanka
Syria
Taiwan
Tajikistan
Thailand
Turkey
Turkmenistan
United Arab Emirates
Uzbekistan
Vietnam
Yemen
Australia
Fiji
Kiribati
Marshall Islands
Micronesia
Nauru
New Zealand
Palau
Papua New Guinea
Samoa
Solomon Islands
Tonga
Tuvalu
Vanuatu
Algeria
Angola
Benin
Botswana
Burkina Faso
Burundi
Cameroon
Cape Verde
Central African Republic
Chad
Comoros
Democratic Republic of the Congo
Republic of the Congo
Djibouti
Egypt
Equatorial Guinea
Eritrea
Ethiopia
Gabon
Gambia
Ghana
Gibraltar
Guinea
Guinea-Bissau
Cote d'Ivoire
Kenya
Lesotho
Liberia
Libya
Madagascar
Malawi
Mali
Mauritania
Mauritius
Morocco
Mozambique
Namibia
Niger
Nigeria
Rwanda
Sao Tome and Principe
Senegal
Seychelles
Sierra Leone
Somalia
South Africa
Sudan
Swaziland
United Republic of Tanzania
Togo
Tunisia
Uganda
Zambia
Zimbabwe
Country / Region
Phone
*
###
-
###
-
####
Mobile Phone
###
-
###
-
####
Work Email Address
*
Do you authorize UNIGLOBE Travel Innovations Ltd. to send you a monthly Newsletter via email?
*
Yes
No
Emergency Contact and Phone Number
TRAVEL PREFERENCES
Preferred Airlines
Air Canada
American Airlines
Delta Air Lines
Lufthansa
Porter Airlines
Westjet
United
US Airways
Other
Frequent Flyer Numbers
AAdvantage
Aeroplan
MileagePlus
Skymiles
VIPorter
Westjet Rewards
Preferred Departure Airport
Class of Service
Seat Preference
Aisle
Window
Front
Rear
Other
Preferred Hotels
Best Western
Crowne Plaza
Delta
Four Seasons
Hilton
Holiday Inn
Hyatt
Inter-continental
Marriott
Sheraton
Westin
Other
Hotel Loyalty Program Numbers
Please list the applicable hotel programs with number
Car Rental Preference
Avis
Budget
Enterprize
Hertz
National
Other
Car Rental Reward Programs
Avis-Wizard Number
Budget-Fastrak
Hertz-Gold Club
Enterprise Plus
National-Emerald Club
PAYMENT INFORMATION
Credit Card
Card Number
Expiration
MM
/
YY
CVV
What is this?
3 or 4 digit number printed on the back/front of your credit card
Protected in vault
Data collected via fields that have our security seal are encrypted and stored with the highest global security standard — PCI compliance. Your data is absolutely safe in Vault.
Credit Card
Card Number
Expiration
MM
/
YY
CVV
What is this?
3 or 4 digit number printed on the back/front of your credit card
Protected in vault
Data collected via fields that have our security seal are encrypted and stored with the highest global security standard — PCI compliance. Your data is absolutely safe in Vault.