University of Pennsylvania
Reservation Request Form

Visitors, official guests, staff and faculty that are seeking access to negotiated rates should use this form.
When applicable, university affiliation documents or a credit card may be required at check in.

Please note this is a request form only, not a confirmation. If space is available, you should receive a notification
from the hotel within 24 hours. If you don’t, or if you need to cancel or amend this reservation, please contact the hotel directly.
Required data is indicated by *  
Nature of Booking: *
Type of Traveler:
University of Pennsylvania Department (if applicable)
Purpose of Travel:
Traveler Contact Information:  
   Contact E-mail: *
   Contact Telephone: *
   Contact Fax:
Travelers *  
   Authorized Traveler 1:
   Authorized Traveler 2:
   Authorized Traveler 3:
   Authorized Traveler 4:
Preferred Hotel:
Restate Preferred Hotel:
(for purposes of emailing)
Travel Information  
   Arrival Date: *
   Departure Date: *
   Length of Stay - Number of Nights:
   Number of Rooms:
   # of People per Room:
   Nightly Rate:
   Estimated Total:
   Smoking/Non Smoking:
   Room Type:

Hotel services paid by University funds:

  

     Yes No
Checking yes indicates that University of Pennsylvania
Is paying except for the incidentals.

  
Form of Payment:
University Sponsor Information  
This section is to be completed only when the
accommodations are being paid for by University
of Pennsylvania!		  
University of Pennsylvania will not accept responsibility
for payment of any reservation that has not been
approved by the sponsoring department prior to stay.		  
Sponsoring Department:
Department Contact Name:
Department Contact Email:
Department Contact Phone:
Department Contact Fax:
Comments:
Special Requests:
Please send comments, questions and/or suggestions to:    larry@campustravel.com