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? *

Yes

No

First Name *

Last Name *

Address *

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: *

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: *

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

Number of points/miles:

Award/Loyalty program

Number of points/miles:

Award/Loyalty program

Number of points/miles:

Award/Loyalty program

Number of points/miles:

Award/Loyalty program

Number of points/miles:

Award/Loyalty program

Number of points/miles:

Award/Loyalty program

Number of points/miles:

Award/Loyalty program

Number of points/miles:

Other program(s)?

Number of points/miles:

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:

Room Preference

Standard

Deluxe

Suite

Any

Trip Date and Time

Number of Travelers *

Airline:

Confirmation Number:

Departure Date * +

Return Date * +

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:

Flexible?

Yes

Ideal Return Date * +

Preferred Return Time

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 *

Credit Card Number *

Expiration Date (mm/yy) *

Security number on the back (3 digits) *

4-digit code on the front *

Is your billing address the same as your address above? *

Yes

No

First Name

Last Name

Street Address

Address Line 2

City

State

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. *

Yes