The University of Texas Medical Branch



Reservation Request


* indicates a required field
Contact Information
Travel Arranger: *
E-mail address of Travel Arranger: *
Phone number: *
Fax number: *

If different from Travel Arranger, please provide:
CBA Custodian's name:
E-mail address of CBA Custodian:
Phone number:
Fax number:

If this request includes Airfare, please enter the last six digits of your CBA account

Please select what type of transaction this will be:
**for changes or cancellations, please indicate original departure date and traveler name:


Special preferences will be requested based on your travel profile. If incomplete or no profile exists, please update your traveler profile

Traveler Information
Name: *
Employee ID number:
Department Name:
Purpose of travel:
Delivery Information (If not an Electronic Ticket)
Address 1:
Address 2:
Deliver To:
Department Name:
Route Number:
City: State:
Zip Code:
-
Airline Travel Arrangements (If Multi Leg Flight, please provide details in the remarks section below)

AN ELECTRONIC TICKET (ETKT) WILL BE ISSUED UNLESS OTHERWISE REQUESTED IN THE REMARKS SECTION.

NOTE: STATE CONTRACT FARE WILL BE QUOTED IN ADDITION TO OTHER FARES REQUESTED. >
Type of airfare:
Departure Airport, City, and State:  William P. Hobby Airport - Houston, TX
  George Bush Intercontinental Airport - Houston, TX
  >Other
Departure date:
Approximate Time OR
Airline and Flight number of departure:
Destination City and State:
Return City and State:
Return date:
Approximate Time OR
Airline and Flight number of return:
Remarks:
Airline resevation paid from Federal Funds?: YesNo
Car Rental Arrangements
Car rental company:
Car type / size:
Special requests:
Hotel Accommodations
Preferred hotel:
Alternate hotel:
Check-in date:
Check-out date:

Guarantee for late arrival: *** If a credit card number is not included in your current CWT Traveler Profile, an agent will contact you via phone for a valid number.

Room type:
Size of bed:
Special requests:
For travel related questions call (800) 798-0292

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