In order that we may assist you faster with your travel plans, please fill out the form below and send it to us by clicking "submit." Or, if you prefer, complete the form, print it out on your printer and fax or mail it to:

Perkins Travel Corporation
40 South High Street
New Britain, CT  06051

(860)  827-4546 - Corporate Fax

Corporate Info:

Name:    Company: 

Title and Cost Center:    

Address 1:

Address 2:

City:           

State:                                   Zip Code:

Business Tel:                 Business Fax:         4erCell Phone:

Email Address:                Assistant:  

Personal Info:
Home Address:   

City:    State:    Zip:

Home Phone:    Emergency Contact:       Date of Birth: 
Gender:       Redress Number (optional): 

Airline Preference:

Airline

Frequent Flyer Number

Status

Seating Preference:               Comments?  

Are there any carriers you feel strongly about voiding?     Comments?  

Are you comfortable with commuter, turbo-prop equipment? 
Would you like us to order special meals for you?     Comments?  

Hotel Preferences
Hotel Club Membership Number
Request non-smoking rooms?
Room Type?
Other Rqst?

Car Preferences
Car Vendor Membership Number
Request non-smoking car?
Car Size?
Other Rqst? 

Discounts
Please advise if you qualify for any discounts (i.e. Senior Citizen, AARP,AAA,Student, Military):   

International Travel
Passport Number:   Expiration:
Citizen of:
Valid Visa(s): 

Form of Payment
Airline Tickets:      Card #:   Exp. Date:       CID #:
Hotel Guarantee:   Card #:   Exp. Date:       CID #: