| Agency Name_________________________________ IATA/TRUE #_____________________ |
| Agency
Address_________________________________________________________________
City________________________ State_______________ Zip
Code_______________________ |
| Phone __________________________________
Fax__________________________________ |
| Web
Site_______________________________________________ |
| Contact
Person___________________________________________
Position________________ |
|
Email__________________________________________________ |
| By my signature, I verify that our agency does not
participate in rebating to clients. |
|
Signature______________________________________________
Date____________________ |
| |
| Fax to: 610 286 6262 |
| |