Airline Upgraded Boarding Reimbursement Claim Form
Airline Upgraded Boarding Reimbursement Claim Form
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Flight Number
*
Flight Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Boarding Pass Upload
*
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Proof of Upgraded Boarding Purchase (e.g., receipt, confirmation)
*
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Amount Claimed (in USD)
*
Reason for Upgraded Boarding
*
Missed original boarding group
Travel urgency
Connection time constraints
Other
Additional Comments (optional)
Submit Claim
Should be Empty: