TEMPLATE CORP Internal Reservation Form

HOTEL RESERVATION FORM ( Internal)

* Indicates required field

Please fill out the following information to request a hotel reservation for a _______________ Employee or Guest

Guest First & Last Name *

First

Last

REQUESTED HOTEL *

Arrival Date (mm/dd/yy) *

Departure Date (mm/dd/yy) *

Room Type: *

Select One *

Additional Room Requests *

Reservation Submitted by:

Employee Name *

Email Address *

UPON SUBMISSION, A MEDICAL TRAVEL CONCIERGE WILL PLACE YOUR HOTEL RESERVATION AT SELECTED HOTEL AND SEND YOU YOUR CONFIRMATION # AND INSTRUCTIONS TO CONTACT THE HOTEL TO PROVIDE YOUR CREDIT CARD WITHIN 72 HOURS FROM MAKING THE RESERVATION UNLESS NOTED THAT THE COMPANY CARD ON FILE ASSOCIATED WITH THE DEPARTMENT SUBMITTING THIS FORM WILL BE UTILIZED. THE RESERVATION WILL BE CANCELLED IF A CREDIT CARD IS NOT PLACED ON THE RESERVATION. IF YOU HAVE ANY QUESTIONS FEEL FREE TO CONTACT US AT (702) 202-2107 OR AT INFO@MEDTRAVELCONCIERGE.COM. BY SUBMITTING A HOTEL RESERVATION REQUEST THROUGH OUR SITE, YOU MUST ABIDE BY THE HOTEL’S CANCELLATION POLICIES. EVENTURE ( DBA MEDICAL TRAVEL CONCIERGE) IS NOT FINANCIALLY RESPONSIBLE FOR THE RESERVATION OR ANY OTHER CHARGES ASSOCIATED WITH THE RESERVATION. *

I Understand And Agree To The Above

Submit