Piedmont Travel
114 S. Main St.,
Kernersville,
NC 27284

 

Online Traveler Profile Form

 

Personal Information

Full Legal Name

   
     
  
Male   Female 
   
   
   
   
   
   
   
   
   

Business Address:

   
   
 
   

Home Address:

   
   
   
   
   
   
 

Passport Information:

   
   
   
   

Airline Preference & Frequent Flyer Information:

   
Aisle   Window   
 

Preferred Airlines

Account Number

   
   
   
   
   
   
   

Note: The name on your ticket must match the name listed on your frequent flyer account to receive credit.

Hotel Preferences & Frequent Guest Information

Non-Smoking  Smoking  King Bed  2 Double Beds 
 

Preferred Hotel Chains

Frequent Guest Number

   
   
   
   
   

Rental Car Preferences & Express Rental Information

Economy Car  Intermediate Car 
Compact Car  Full Size Car 
   

Preferred Rental Car Vendors

Express Rental Personal ID Numbers

   
   
   

Additional Information

Credit Card Information

Card Type*

Name On THe Card*

Account Number*

Expiration Date*

CCV Number*


A Credit Card is Mandatory to Book Hotel Rooms
 Yes please subscribe me to piedmont travel alerts and e-newsletter
 
Note:Your information is delivered to Piedmont Travel via an encrypted format for your protection and security.However, you may want to call us on the telephone with some fields such as credit card account numbers and passport information.Please understand Piedmont Travel group is not for information being sent via the internet.
 
   
 
Note:Upon successful submission a "Thank You" page will display.
 
 

Piedmont Travel
114 S. Main St.,
Kernersville, NC 27284
(336) 992-2828
(800) 650-7003 Toll Free