DOMESTIC TRAVEL REQUEST

Trip #

Sabre Locater # (received from Travel Office)

Date:

ESTIMATED COST: $

Account #

PRE-APPROVAL:

Name:

Life #

Home Phone:

Bldg:

Ext:

Division Head:

Home Address:

Travel To:

Purpose of Trip:

Date of Departure:

Depart City/Airport:

Depart Approx. Time:

Add’l. Destination Depart:

Depart City/Airport:

Depart Approx. Time:

Add’l. Destination Depart:

Depart City/Airport:

Depart Approx. Time:

Date of Return:

Depart City/Airport:

Depart Approx. Time:

Airline Seat Assignment Preference: Aisle Window

Frequent Flyer No:

Are vacation days included? Yes No (If Yes, state number of days and dates )

Will you be driving to your destination? Yes No (If Yes, will you use your car or BNL car? )

If Using BNL Vehicle: Pick up Date and Time Return Date and Time

If more than one traveler, state name(s)

Car Rental? Yes No Preference:

Limo? Yes No Preference:

Hotel? Yes No

Hotel Preference

Registration Fee? Amount: Due Date: Pre-paid by BNL Paid by you (to be reimbursed)

(AMEX, DC, MC, V) Please supply credit card number and expiration date to secretary, when requested.

Check Travel Advance? Yes No If yes, Amt. $

Area per diem: $

(Requires an exception advance request memo approved by the Dept. Chair) County of Travel:

NOTES: RETURN COMPLETED FORM TO: Group Secretary/Bldg. #

DAYS Business: Travel: Vacation: Weekend: TOTAL:

Please Note the Following: 1) All travel arrangements and hotel accommodations (except those arranged by a specific conference) must be booked through the BNL travel office. 2) Hotel rate should be in accordance with the maximum lodging rate allowed by the accounts department. Any amount above that rate will not be refunded. 3) You are expected to make your own ferry arrangements.

BNL Agent:

(If you have made your own reservations with BNL Travel, state agent’s name.)