4700 S. Wadsworth Blvd.
Littleton, Colorado 80123
Phone: 303-932-6914
Fax: 303-932-1124

Click here for the Pre Authorization Expense Form

Time Off Request Form

Name: *

Start Date: *
Return Date: *
Reason (Vacation, Travel, Personal, etc...): *
Territory Coverage By: *

Travel Protocol

Flight Request

Rep Name:
Full Travel Name (if Different from above):
Date of Birth:
Flight Departure Date:
Departure City:
Arrival City:
NEEDED Time of Arrival:
Airline Carrier:
Flight Number:
ONE-WAY Estimated Cost:
Return Flight Date:
Minimum Time of Departure:
Airline Carrier:
Flight Number:
Estimated Cost (if not a round trip):
TOTAL Estimated Cost:

Hotel Request

Check in Date:
Hotel Chain:
Number of Nights:
Check Out Date:
Estimated Cost:

Car Rental Request

Pick Up Date:
Car Rental Company:
Number of Days Needed:
Drop Off Date (Return Date):
Estimated Cost:

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