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Booking Form
To best assist you with your request, please fill out this form completely and we will contact you shortly.
Traveler Information
Please fill out this information as it appears on your ID (passport for international or drivers license for domestic)
Are you currently a member of Points Simplified?
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Yes
No
First Name
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Last Name
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Address
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City
*
State
*
Zip Code
*
Passport Number (required for all international travel)
Date of Birth
*
Email Address
*
Phone
*
Award Information
Please select the service(s) you are requesting:
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Basic award booking - $175 (one-way or round-trip flights booked using miles or points)
Advanced award booking - $250 (any complex ticket other than one-way or round-trip flight booked using miles or points)
Flight upgrade - $85/person (upgrade flight class of service, such as economy to business/first using cash, miles, or points)
Hotel award booking - $125 (booking and upgrading hotel rooms using miles or points)
Miles and points consultation - $125 (Analyze points and miles and recommend programs and cards to reach travel goals)
Credit Card Consultation - $125 (Analyze and review current cards, then recommend which card(s) to use to obtain your travel goals)
Please select the service(s) you are requesting:
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Basic award booking - $140 (one-way or round-trip flights booked using miles or points)
Advanced award booking - $200 (any complex ticket other than one-way or round-trip flight booked using miles or points)
Flight upgrade - $68/person (upgrade flight class of service, such as economy to business/first using cash, miles, or points)
Hotel award booking - $100 (booking and upgrading hotel rooms using miles or points)
Miles and points consultation - $100 (Analyze points and miles and recommend programs and cards to reach travel goals)
Credit Card Consultation - $100 (Analyze and review current cards, then recommend which card(s) to use to obtain your travel goals)
Please provide the programs you are a member of and how many points/miles in those programs to better assist us in getting you the best use of your points/miles.
Award/Loyalty program
Aeroplan
Alaska Mileage Plan
American AAdvantage
American Express
ANA Mileage Club
Capital One
Chase Ultimate Rewards
Choice Priveledges
Citi Thankyou
Delta Skymiles
Hilton Honors
Hyatt Hotel Program
IHG Rewards Club
Lufthansa Miles & More
Marriott Rewards
Southwest Rapid Rewards
Starwood Preferred Guest
United MileagePlus
Visa Signature
Number of points/miles:
Award/Loyalty program
Aeroplan
Alaska Mileage Plan
American AAdvantage
American Express
ANA Mileage Club
Capital One
Chase Ultimate Rewards
Choice Priveledges
Citi Thankyou
Delta Skymiles
Hilton Honors
Hyatt Hotel Program
IHG Rewards Club
Lufthansa Miles & More
Marriott Rewards
Southwest Rapid Rewards
Starwood Preferred Guest
United MileagePlus
Visa Signature
Number of points/miles:
Award/Loyalty program
Aeroplan
Alaska Mileage Plan
American AAdvantage
American Express
ANA Mileage Club
Capital One
Chase Ultimate Rewards
Choice Priveledges
Citi Thankyou
Delta Skymiles
Hilton Honors
Hyatt Hotel Program
IHG Rewards Club
Lufthansa Miles & More
Marriott Rewards
Southwest Rapid Rewards
Starwood Preferred Guest
United MileagePlus
Visa Signature
Number of points/miles:
Award/Loyalty program
Aeroplan
Alaska Mileage Plan
American AAdvantage
American Express
ANA Mileage Club
Capital One
Chase Ultimate Rewards
Choice Priveledges
Citi Thankyou
Delta Skymiles
Hilton Honors
Hyatt Hotel Program
IHG Rewards Club
Lufthansa Miles & More
Marriott Rewards
Southwest Rapid Rewards
Starwood Preferred Guest
United MileagePlus
Visa Signature
Number of points/miles:
Award/Loyalty program
Aeroplan
Alaska Mileage Plan
American AAdvantage
American Express
ANA Mileage Club
Capital One
Chase Ultimate Rewards
Choice Priveledges
Citi Thankyou
Delta Skymiles
Hilton Honors
Hyatt Hotel Program
IHG Rewards Club
Lufthansa Miles & More
Marriott Rewards
Southwest Rapid Rewards
Starwood Preferred Guest
United MileagePlus
Visa Signature
Number of points/miles:
Award/Loyalty program
Aeroplan
Alaska Mileage Plan
American AAdvantage
American Express
ANA Mileage Club
Capital One
Chase Ultimate Rewards
Choice Priveledges
Citi Thankyou
Delta Skymiles
Hilton Honors
Hyatt Hotel Program
IHG Rewards Club
Lufthansa Miles & More
Marriott Rewards
Southwest Rapid Rewards
Starwood Preferred Guest
United MileagePlus
Visa Signature
Number of points/miles:
Award/Loyalty program
Aeroplan
Alaska Mileage Plan
American AAdvantage
American Express
ANA Mileage Club
Capital One
Chase Ultimate Rewards
Choice Priveledges
Citi Thankyou
Delta Skymiles
Hilton Honors
Hyatt Hotel Program
IHG Rewards Club
Lufthansa Miles & More
Marriott Rewards
Southwest Rapid Rewards
Starwood Preferred Guest
United MileagePlus
Visa Signature
Number of points/miles:
Award/Loyalty program
Aeroplan
Alaska Mileage Plan
American AAdvantage
American Express
ANA Mileage Club
Capital One
Chase Ultimate Rewards
Choice Priveledges
Citi Thankyou
Delta Skymiles
Hilton Honors
Hyatt Hotel Program
IHG Rewards Club
Lufthansa Miles & More
Marriott Rewards
Southwest Rapid Rewards
Starwood Preferred Guest
United MileagePlus
Visa Signature
Number of points/miles:
Other program(s)?
Number of points/miles:
Which Credit Cards do you currently have?
Which Credit Cards do you currently have?
Which Credit Cards do you currently have?
Which Credit Cards do you currently have?
Do you have an elite status with an airline? If so, which airline(s) and which level?
Do you have an elite status with a hotel? If so, which hotel(s) and which level?
Preferred class of service:
Economy
Premium Economy/Economy Plus
Business
First
Any
Room Preference
Standard
Deluxe
Suite
Any
Trip Date and Time
Number of Travelers
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Airline:
Confirmation Number:
Departure Date
*
Return Date
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Flight Number (first flight):
Flight Number (second flight):
Flight Number (third flight):
Flight Number (fourth flight):
Origin
Second City
Third City
Destination City
Ideal Departure Date
*
Preferred Departure Time:
Morning
Afternoon
Evening
Flexible?
Yes
Ideal Return Date
*
Preferred Return Time
Morning
Afternoon
Evening
Flexible?
Yes
Ideal Check-in Date
*
Flexible?
Yes
Ideal Check-out Date
*
Flexible?
Yes
Special Instructions
Billing Information
Name on Card
*
Phone Number
*
Credit Card Type
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Visa
MasterCard
American Express
Discover
Credit Card Number
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Expiration Date (mm/yy)
*
Security number on the back (3 digits)
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4-digit code on the front
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Is your billing address the same as your address above?
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Yes
No
First Name
Last Name
Street Address
Address Line 2
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Zip Code
I hereby authorize Executive Travel to gain access to my frequent flyer miles, hotel points and credit card rewards and use them at my, the client’s, request and to charge my card for the services I select below. Once the ticket or reservation is made, no additional changes will be made by Executive Travel and the client will retain all rights and control over their ticket and reservation. Any information regarding your points and miles account will be kept strictly confidential and not be used for any other purpose other than booking your trip.
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Yes