Airline Tickets From Non-Contracted Sources
Data Collection Form*

Instructions:
To navigate from field to field, use the TAB key.
To submit completed form, use the ENTER key.

Please select your institution from the following list:

Please Specify if not listed above:

Department Code:
(or name if code is unknown)
Name of Traveler:
(as it appears on ticket)
Trip Purpose:

Ticket # (if ticketed) or Confirmation # (if ticketless):

Name of Carrier (as it appears on ticket for initial leg of trip): 
(Choose from this list for Domestic)
(Choose from this list for International)
Other Airline (if not listed)

The Airport you left from:
(3-letter airport code, if known)

The Airport you arrived at:
(3-letter airport code, if known)
City:
 State:
 Country (if overseas):

The Airport you returned to:
(3-letter airport code, if known)

Date of Issue:
Date of Departure:
Saturday Night Stay:
 Domestic or International:

Class of Service:
(if unknown, check with travel agent)
Fare Paid:
$ (Total Fare paid including tax, but not including service fee)
Service Fee:
$
Airline Change Fee and/or Penalty Fee
$

Purchase Method:

If you used a travel agency, please provide the name of agency:

If you used an Internet reservation system, please provide name of internet system:

Form of Payment:

Reason for choosing above:

Last modified: January 05, 2004
Hosted by Campus Travel Management
For questions or comments concerning this form please email larry@campustravel.com