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Passenger Legal First Name
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Middle Name
Last Name
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Date of Birth
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Gender
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Phone Number
Email
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Supervisor
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Please Select
Marc Bodner
Mike Willert
Steve Gedell
Jim Athey
Jonathan Banegas
Tom Tomescko
David Faust
Richard Grant
Paul Gerner
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Please check the boxes for what you need:
Flight
Hotel accommodations
Car rental
L&R Distributors policy is for the employee to use a personal credit card upon check-in to Hotel, and pick-up of Car Rental, and submit the receipts for reimbursement. PEYD will reserve the initial Hotel and/or Car Rental.
Choose Your Itinerary
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One Way
Round Trip
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Departure City
Arrival City
Departure Date
MM slash DD slash YYYY
Preferred Departure Time
Anytime
Early Morning (before 8:00)
Morning (8:00-11:00)
Midday (11:00-2:00)
Afternoon (2:00-5:00)
Evening (5:00-9:00)
Night (after 9:00)
Seating Preference
Choose your seating preference
Aisle
Window
Middle
Return Ticket
Departure Date For Return
*
MM slash DD slash YYYY
Preferred Departure Time For Return
*
Anytime
Early Morning (before 8:00)
Morning (8:00-11:00)
Midday (11:00-2:00)
Afternoon (2:00-5:00)
Evening (5:00-9:00)
Night (after 9:00)
Leg 2
Departure City 2
Arrival City 2
Departure Date 2
MM slash DD slash YYYY
Preferred Departure Time 2
Anytime
Early Morning (before 8:00)
Morning (8:00-11:00)
Midday (11:00-2:00)
Afternoon (2:00-5:00)
Evening (5:00-9:00)
Night (after 9:00)
+ Add another flight
Leg 3
Departure City 3
Arrival City 3
Departure Date 3
MM slash DD slash YYYY
Preferred Departure Time 3
Anytime
Early Morning (before 8:00)
Morning (8:00-11:00)
Midday (11:00-2:00)
Afternoon (2:00-5:00)
Evening (5:00-9:00)
Night (after 9:00)
+ Add another flight
Leg 4
Departure City 4
Arrival City 4
Departure Date 4
MM slash DD slash YYYY
Preferred Departure Time 4
Anytime
Early Morning (before 8:00)
Morning (8:00-11:00)
Midday (11:00-2:00)
Afternoon (2:00-5:00)
Evening (5:00-9:00)
Night (after 9:00)
To which location are you flying?
Corporate Office, 88 35th Street, Building 4, 5th floor, suite D, Brooklyn, NY 11232
Pine Bluff, Arkansas 3017 N. Midland Drive Pine Bluff, AR 71603
Monroe Township (DC 7) - 11 Engelhard Drive Monroe Township, NJ 08831
Reno/Sparks, NV (DC 8) 455 Ingenuity Ave., Spanish Springs, NV 89441
Encinitas, CA (SJ Creations), 175 Calle Magdalena, Encinitas, CA 92024
Hotel Accomodations
Hotel Location/Name
Check in
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Check out
MM slash DD slash YYYY
Car Rental
Pick up Location
Pick up Date
MM slash DD slash YYYY
Pick up Time
:
Hours
Minutes
AM
PM
AM/PM
Drop off Location
Drop off Date
MM slash DD slash YYYY
Drop off Time
:
Hours
Minutes
AM
PM
AM/PM
Frequent Flyer Info
FF Airline Name
FF Rewards/Membership #
+ Add Frequent Flyer Account
FF Airline Name 2
FF Rewards/Membership # 2
+ Add Frequent Flyer Account
FF Airline Name 3
FF Rewards/Membership # 3
+ Add Frequent Flyer Account
FF Airline Name 4
FF Rewards/Membership # 4
+ Add Frequent Flyer Account
FF Airline Name 5
FF Rewards/Membership # 5
Purpose of trip
Passenger Redress/TSA info to keep on file
Special requests/Additional Comments
Tentative itineraries are held until the end of the day and will expire, so please respond in a timely manner to ensure your ticket is issued. Itineraries are not guaranteed until ticketed.
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Please send me additional information about the airline and credit card rewards industry.
