University of Illinois College of Medicine at Peoria
Reservation Request Form

The following form must be used to request direct purchase of discounted hotel rooms using institutional funds. Upon receipt by the hotel, you will receive a prompt acknowledgement of confirmation status, negotiated room rate, sales tax waiver and certification of SBA minority, women owned or small business status. Travelers may be required to show their Campus ID, Corporate Credit Card or authorizing P.O. at check-in to get the discounted rate.
Required data is indicated by *  
Nature of Booking:
UICOMP Connection:
Purpose of Travel:
Direct Purchase Requested by: *     

   Contact Telephone: *

   Contact E-mail: *

   Contact Fax:

Authorized Traveler: *

   Department Name: *

Hotel (including City): *



   Arrival Date: *

   Departure Date: *

   # of Nights: *

   Number of Rooms:

   # of People in Room:

   Nightly Rate:

   Estimated Total:

   Smoking/Non Smoking:

   Requested Confirmation Status:

   Room Type:

Hotel Services:
  Unless otherwise specified and
  approved, UICOMP Policy is that the following
  services cannot be charged to the Institution.

     State of Illinois Sales Tax


     Entertainment (movie charges, etc.)


     Mini Bar


     Spa Services



  UICOMP Policy is that the following services
  can be charged if check-marked yes


     Yes No    Internet Services

     Yes No    Laundry Services

     Yes No    Meals

     Yes No    Other

Accounting References:  

   C-FOAPAL Number:

   Form of Payment:

Special Request:

Important Note: Since Campus Travel Management is based in Maryland and is not a travel agency, we cannot offer reservations, recommendations or insights to this destination. We are, however, always looking for ways to improve the quality of our Travel Portal.
Please send comments, questions and/or suggestions to: