Agency/Participating Entity Profile Form

Profile submissions are transmitted directly to a secure server for the National Travel Profiles Team to access. All profiles are worked in the order received. Please be aware that it may take up to one business day for the profile information to be updated or a new profile built. If a travel reservation needs to be made on the same day that the profile is submitted, please make sure that the NTS agent processing your travel request is aware, so that he/she can contact the Profiles Team to expedite the profile build/update for you.

New or Modification?

Is this a new form or a modification?*

State Agency/Entity Information

State Agency/Entity*

State Agency/Entity #*

Department #

As applicable

Division #

As applicable

Travel Coordinator Information

Travel Coordinator Name*

Street Address*

City*

State*

Zip*

Phone*

Email Address*

Fax #

Department Name

Division Name

CBA Card Information

Cardholder Name*

Credit Card Number*

Expiration Date*

Is your CBA card to be used for air transactions only?*

Hotel Information

Would you like us to book your hotel?*

If no, you may skip this section.

Do you have agency preference for hotel chains?

If you have any hotel club memberships, please enter them below.

Club

Membership #

Name on Card

Club

Membership #

Name on Card

Club

Membership #

Name on Card

Would you like to use a separate card for hotel guarantees?*

If yes, please indicate a credit card number to be used to guarantee hotel rooms:

Cardholder Name

Credit Card Number

Expiration Date

If no, does the traveler use their individual cards for guarantees?

Use traveler's card for guarantees:*

Car Rental Information

Do you have a direct bill arrangement with car companies?*

If you have any car rental club memberships, please enter them below.

Club

Membership #

Name on Card

Club

Membership #

Name on Card

Club

Membership #

Name on Card

Additional Information

Additional info/requests/credit card information

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