Partial ETR Exchange Agent Name* Select NameCharlieChrisDeniseDiJackieJamieJennaJoleenKariKatieKristinLindseyLisaMichelle Agent Email* Company* Passenger* First Last Sort Information Approval Required to apply this ticket?* Yes No If YES, please explain. OSI Information Waiver Information Re-Issue/Travel By* Date Format: MM slash DD slash YYYY ETR/Information* Original Issue Date* Date Format: MM slash DD slash YYYY Remaining Value of Ticket after Penalty* Max. Day* Yes No If Yes, how many days? Expiration Date* Date Format: MM slash DD slash YYYY Route Specific?* Yes No Fare Breakdown* Void Auxillary Segments(?)* NoneCarHotelLimo Additional Comments File
