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My Travel Manager Login
By submitting this secured Travel Profile Form to Landfall American Express Travel, we will be able to easily fulfill your travel preferences and tastes. All information will be kept confidential and only used for Landfall American Express Travel to communicate with you and the Travel Suppliers. After completing this form, you will be able to login at any time to your "My Travel Manager" Account to modify any of your information.




Required Fields To Register For A Travel Manager Account Are Shown In Red
    1. ACCOUNT INFORMATION
Create A Login User Name:   
   
Password:   
   
Repeat Password:   
   
    2. PERSONAL INFORMATION
Salutation:   
(Mr., Mrs., Ms., Dr., etc.)   
   
Your First Name:   
(As It Appears On Your Passport)   
   
Your Last Name:   
(As It Appears On Your Passport)   
   
eMail Address: (Required)   
   
Address Line 1:   
   
Address Line 2:   
   
City:   
   
State:   
      Zip Code:
Home Telephone: (With Area Code)   
   
Cellular Telephone: (With Area Code)   
   
Date Of Birth: (MM/DD/YYYY)   
   
AARP #:   
   
AAA #:   
   
    3. COMPANY INFORMATION
    Basic Information In This Section Can Be Pre-Coded With Your Company/Oragnization Information
    - As Shown Below
Company/Organization Name:   
   
Address Line 1:   
   
Address Line 2:   
   
City:   
   
State:   
      Zip Code:
Company Telephone: (With Area Code)   
   
FAX Telephone: (With Area Code)   
   
Title:   
   
Department:   
   
Employee #:   
   
Location #:   
   
    4. CITIZENSHIP INFORMATION
Country Of Citizenship:   
   
Passport Number:   
   
Passport Issue Date:   
   
Passport Expiration Date:   
   
    5. FOREIGN COUNTRY VISA INFORMATION
Country #1:   
   
VISA #1:   
   
Expiration Date #1:   
   
Country #2:   
   
VISA #2:   
   
Expiration Date #2:   
   
List Any Multi-Entry Visas:   
   

Special International Travel Instructions:



    6. EMERGENCY CONTACT INFORMATION
Name Of Emergency Contact:   
   
Relationship:   
   
Their Telephone: (With Area Code)   
   
    7. TRAVEL PLANNER INFORMATION
Travel Planner's Name:   
   
eMail Address:   
   
Phone:   
   
Your Travel Agent:   
   
    8. TRAVEL PREFERENCES
I Usually Travel For:   
    Business Leisure Both
Usual Vacation Dates:   

From:   
To:   


   
   
Favorite Destination(s):   
   
    9. FORM OF PAYMENT / CREDIT CARD GUARANTEE
Register Your Credit Card #1:   
    Card Type
    Name On Card
    Card Number
    Exp.Date    Billing Zip Code
   Card Security Code Click For Help
Register Your Credit Card #2:   
    Card Type
    Name On Card
    Card Number
    Exp.Date    Billing Zip Code
   Card Security Code Click For Help
Register Your Credit Card #3:   
    Card Type
    Name On Card
    Card Number
    Exp.Date    Billing Zip Code
   Card Security Code Click For Help
    10. AIR PREFERENCES
Form Of Payment: (From Above)   
    Card # 1 Card # 2 Card # 3
I Like To Fly:   
    First Class Coach
    Business Doesn't Matter
Seat Location:   
    Forward Rear Exit Row
    Bulkhead Doesn't Matter
Seating Preference:   
    Aisle Window
    Center Doesn't Matter
Special Services Required:   
   
Airline Preference:
Frequent Flyer Number:








Special Airline Elite Status Information:



    11. AIRLINE HEALTH / DIET REQUIREMENTS
Diabetic Low Calorie Low Cholesterol Salt Free Vegetarian
Other:

Please Apply This To My Flights With Meal Service As Follows:
All Meals & Snacks All Meals All Meals Except Breakfast
    12. HOTEL PREFERENCES
Form Of Payment Guarantee: (From Above)   
    Card # 1 Card # 2 Card # 3
Hotel Room Smoking Preference:   
    Smoking Non-Smoking Doesn't Matter
Room Size:   
    Twin Double Queen King Suite
    Best Rate Doesn't Matter
Special Services Required:   
   
Hotel Preference:
Frequent Guest Number:







    13. CAR RENTAL PREFERENCES
Form Of Payment Guarantee: (From Above)   
    Card # 1 Card # 2 Card # 3
Car Type:   
    Economy Compact Mid-Size
    Full-Size Luxury Speciality
Special Services Required:   
   
Rental Company Preference:
Frequent Renter Number
And Preferred Airline For Milage Credit:







    14. eMAIL PREFERENCES
Subscribe To Our eNewsletters   
  Weekly Travel Specials
  Last Minute Specials

Additional Remarks Or Comments



By submitting this form, I hereby appoint the employees of Landfall American Express Travel travel agency who handle my account to be my attorneys-in-fact for the purpose of signing all documents necessary to purchase and issue airline tickets and other travel documents, and to charge these purchases to the credit card(s) indicated in this form. I authorize any of the attorneys-in-fact to sign credit card authorizations for the purchase of airline tickets and other travel documents whenever any of them receives instructions reasonably believed to be from me or someone acting on my behalf, requesting those tickets be charged to my credit card account. I agree that I will pay for all such purchases and will not hold Landfall American Express Travel travel agency responsible for any of its actions pursuant to this power of attorney.

All information will be kept confidential and will be used by Landfall American Express Travel to communicate with you and the Travel Suppliers. This information may be shared with representatives of your company/organization as requested.

To Continue, You Must Click Here To Confirm The Above Statement. (Required)


Please re-enter the Security Code Number shown above:


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