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Executive Hotel Stay Questionnaire


Sponsoring Company Name:                  
Sponsoring Company Address:
                                            City:   State:     ZIP:
Employee First Name: MI: Last Name:
Employee Address:
                                            City:   State:     ZIP:
Company HR Dept. Phone:
Employee Home Phone:                 Employee Work Phone:
Date of Arrival:                         Date of Departure:
Number of Rooms Needed:
You will be accompanied by: Spouse/Companion       Child(ren)
Per Day Maximum Room Rate:   
Room Rate Budget:     $100-$200    $200-$250    $250-$300    $300-$350
                                           $350-$400    $400-$450    $450-$500    $500-$550    $550+  
Traveler's Health/Accident Insurance Needed    Yes    No

Location in Manhattan (Check all that may apply)
Upper Eastside (42nd St. & above, York Av. - East of 5th Av.) 
Upper Westside (42nd St. & above, West of 5th Av. -12th Av.)
Midtown (23rd St. -42nd St., east & west)     
Lower Eastside (14th St. -  23rd St., East of 5th Av.)    
Lower Westside (14th St. - 23rd St., West of 5th Av. -12th Av.)
Lower New York (14th St. & below, east & west)
Indicate more specific locations:

Hotel / Room:
Single Occupancy    Double Occupancy
Non-Smoking    Smoking    No Preference
Floor Preference:

Separate Bedroom Yes No No Preference
Kitchenette         Yes No No Preference
Health Club Yes No
Child Care Yes No
Internet Access Yes No
Business Computer Center Yes No
Safe Deposit Yes No
Special Security Arrangements Yes No
Accommodation for Disability Yes No
Translator Yes No
Tour Guide Yes No
Transportation needed from the Airport Yes No
Rental Car Needed Yes No
Car and Driver needed Yes No
Need Assistance with:
Theater Reservations >

     Restaurant Reservations >

     Other, please specify: >
Yes No
Yes No
Permanent Housing after >

     Hotel Stay >

If yes: >
Yes No
Rentals Condominium
House Coop