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Travel Rewards Request Form

I have reviewed and understand the Travel Rules and cancel policy.

My owner/manager has provided approval to redeem "Fun-Jets" for this Travel Reward or I am the owner/manager.

I understand that Travel Redemptions are subject to 1099 Reporting.

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Agency Information
 
Agency Name:
Agency ARC/VAX #
Agency Phone #:

Travel Agent Information

Agent Fun for Life ID:
Agent's E-Mail Address:
Agent's Legal First Name:
Agent's Legal Middle Name:
Agent's Legal Last Name:
Date of Birth
Gender M F

Travel Guest #1

Legal First Name
Legal Middle Name
Legal Last Name
Age (if child)
Date of Birth
Gender M F

Travel Guest #2

Legal First Name
Legal Middle Name
Legal Last Name
Age (if child)
Date of Birth
Gender M F

Travel Guest #3

Legal First Name
Legal Middle Name
Legal Last Name
Age (if child)
Date of Birth
Gender M F

Preferred Travel Date
Alternative Travel Date

Hotel Selection

1st Choice Hotel:
2nd Choice Hotel:
3rd Choice Hotel:
Number of Nights
Transfer Needed Yes No
Transfer Comments

Charter/Value Air Selection

Arrival Flight Time am pm
Carrier
Flight #
Origin
Destination

Return Flight Time am pm
Carrier
Flight #
Origin
Destination

Provide any comments & review travel rules

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