EmailMe Form - PASSENGER INFORMATION SHEET INDIVIDUAL CREDIT CARD

PASSPORT DETAILS

Company *

Position Title

Department

Cost Centre

Passenger Name (As shown in passport)

Prefix First Middle Last

Mobile Number (including country code)

Landline

E-mail Address

Personal Address

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

Passport No.

Copy of Passport

Passport Issue Date

DD / MM / YYYY

Passport Expiry Date

DD / MM / YYYY

Date of birth

DD / MM / YYYY

Country of passport

TRAVEL DETAILS

Seating Preference

Window

Aisle

Upper Deck

Main Deck

Airline Frequent Flyer Numbers (Airline and Number)
Please list all memberships

Hotel Card Numbers
Please list all memberships

Car Hire Memberships
Please list all memberships

Special meals (Vegetarian, kosher, etc)

Emergency Contact Name and Mobile number

Corporate Credit card type *

Name as per the credit card *

First Middle Last

Credit Card

File Upload *

PRIVACY STATEMENT

"I/We acknowledge that I/we will provide Spencer Travel Pty Ltd ('the Agent') from time to time with information about myself / ourselves of a personal nature (personal Information").

"I/We (Client) consent to 'the Agent' using any personal information supplied by me/us for the purposes of making and completing airline bookings and travel related arrangements on behalf of me /us".

Authorisation of Future Payments *

This Credit Card Authority is a standing Authority and will apply in respect of all transactions between THE AGENT and the Card Holder from the date of this authority until the authority is revoked by notice in writing by the Card Holder to THE AGENT

The Card Holder utilizes the services of SPENCER GROUP OF COMPANIES PTY LTD (‘THE AGENT’) on a continuous basis for the Card Holders travel requirements.

In order to facilitate payment for travel arrangements between the Card Holder and THE AGENT, the Card Holder confirms that all orders placed with THE AGENT are to be charged to the Card Holders credit card or cards circled below. If more than one credit card is noted by the Card Holder, then the Card Holder will advise THE AGENT of which card to utilize in relation to each order, but if no direction is given in that regard, THE AGENT is authorized to charge the order against the Card Holder’s credit card as nominated as one (1) on the list.

THE AGENT reserves the right to obtain proof of identification in the form of a copy of a signed drivers license, passport or photo ID to verify identity of the Card Holder.

Name

Prefix First Last

Signature

Clear

Date Time

DD / MM / YYYY