Associate's Name  Date Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2020 2020  

Branch Bartlesville Office Tulsa Office  

Type of Travel :  (Please Check One)
                                  Business      Describe
                                  Educational  Describe
                                  Personal           

Request For:        (Please Check One)
                                Associate Only
                                Associate /Companion

 Companion Name Relationship 

                            Domestic
                            Other   

Departure Date Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2020 2020     Return Date Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2020 2020  

Routing  

Record Locator    IATAN Card Nbr
 

Please fax or mail request to the Downtown Bartlesville office,
 Attention: Gary Spears
(As a safety measure, please notify by e-mail that you have sent your request) 

 Approval ___________________________________    Date ____________                    
(Branch Office Manager Only)