You are on page 1of 1

PetSafe booking request form

To request a booking using United’s PetSafe® program, please follow two easy steps: 1) Complete this form 2) Submit the completed form by email to petsafe@united.com or print and fax to 1-713-324-3074 Within three business days of your submission, a qualified PetSafe representative will provide you with an email confirmation of your booking along with safe shipment instructions. Shipper information
* S hip p e r na m e * Email a d dre ss

Submit
* Indicates mandatory field

Lucien Veil

ushugal@gmail.com

* Prima r y p h o n e n u m b e r S e co n da r y p h o n e n u m b e r

(608) 372-1060

*Ad dre ss (street/city/state/zip/country)

12853 Flattop Rd., Tomah, WI 54660

Milea ge Plus ® a cco u nt n u m b e r (if applicable)

  Is shipper active U.S. Military or active Foreign Services (DOS, FSP) traveling on Permanent Change of Status (PCS) or temporary leave, with government orders? s  No  Yes   

Travel information

 O n e way

s Ro u n dtrip  

Will th e a nimal b e a cco m p a nie d by a p ass e nge r ? s  Ye s       N o * D e p a r tu re cit y/s tate/co u ntr y

If ye s , pleas e p rovid e th e p ass e n ge r ’s re s e r vatio n co nf irmatio n n u m b e r. (Fo u n d o n yo u r itin era r y a n d re ceipt fo r co nf ir m atio n)

NF591X or NEMC4J

Chicago IL. USA

D e p a r tu re airp o r t (name or 3-character code)

Chicago - ORD O'Hare

* D e p a r tu re date (MM/DD/YY) *A rrival cit y/s tate/co u ntr y

09/26/12

Pre fe rre d d e p a r tu re tim e (e.g., morning, mid-day, evening) A rrival airp o r t (name or 3-character code)

2:30 PM

Frankfurt
10/24/12

Frankfurt - FRA Germany

* S ug ge s te d ro u tin g / tra nsit airp o r t (if applicable) Re tu rn date (for roundtrip requests only)

Pre fe rre d retu rn tim e (e.g., morning, mid-day, evening)

morning

Ro u n dtrip, d e p a r tu re cit y/s tate/co u ntr y (if different from original arrival location) Ro u n dtrip, a rrival cit y/s tate/co u ntr y (if different from original departure location) U nite d C a rgo a cco u nt n u m b e r ( if available) A ir waybill n u m b e r ( if available)

Frankfurt - FRA Germany
Chicago - ORD O'Hare

Animal information
A nimal #1 *A nimal t y p e (e.g., dog, cat, etc.) * B re e d * Weig ht (in pounds) *A ge (yea r s/m o nths/w eek s) * Ke n n el dim e nsio ns (L” x W” x H” in inches) A nimal's na m e A nimal #2 A nimal #3 A nimal # 4 A nimal #5

Dog

Dog

Cockapoo
25

Lhasa Apso
15

3 years
28" x 20.5" x 21.5"

5 years
In-Cabin-Pet

Rollo

Herman

Contact information at destination
* Re cipie nt na m e * Email a d dre ss

Tony Ancona

crimsonmoon666@hotmail.com
(+49) 1766 234 9461

* Prima r y p h o n e n u m b e r S e co n da r y p h o n e n u m b e r

(+49) 6304 923 594
Muhlberg 30, 67756 Hinzweiler, Germany

*Ad dre ss at d e s tinatio n (street/city/state/zip/country)

Additional comments

Only Dog #1 (Rollo) is going in the Pet Cargo,His Conf. #: EL995448. Our Confermation #: Lucien Veil - NF591X,
Animal shipping instructions.

Dog #2 (Herman) is flying In-Cabin with us, his Confermation #: NENMLB Juliette Yu - NEMC4J (Herman was booked with Juliette Yu)

 I certify that I have read, fully understand and agree to the requirements for shipping animals with PetSafe as outlined in

For internal use
Date re ceive d Co m pletio n date If n ot co m plete , explain A ge nt ID Pro ce ss co m ple te  Ye s  N o

Related Interests