Travel Agent Registration

APPLICATION FOR PEREGRINE TRAVEL GROUP AGENT BOOKING NUMBER

Please complete all questions (* = Required Information)

Address / Telephone Information*
Agency Name *:
Street Address *:
City *:
State *:
Zip *:
Country *:
Telephone Number *:
Fax Number *:
ARC/CLIA/IATA Number *:
Are you currently in the process of an ARC/IATA application?

Yes No
Is your business also a residence?

Yes No Year Started in Business:
Agency Information*
Owner's Name *:
Owner's Email *:
Your Name *:
Your Email *:
Your Telephone Number *:
Your Fax Number *:
Desired Username *: (6-12 characters)
Desired Password *: (6-12 characters)
Does your agency have one of the following insurances?

Errors & Omissions Bond None
Number of Agents:
Full Time:
Part Time:
Outside:
How many sell leisure travel?:

Total agency Annual Sales *:

Less than $500,000	$500,000-$999,999	$1M-$2,999,999
$3M-$4,999,999	$5 M - $10 M	More than $10 M

Total agency Annual Sales to China *:

Less than $500,000	$500,000-$999,999	$1M-$2,999,999
$3M-$4,999,999	$5 M - $10 M	More than $10 M

Does your agency have more than one location?

Yes No How many?:
Is your agency a member of any consortiums or franchises* ?

Yes No If yes, please list below:
Is your agency a member of any associations *?

Yes No If yes, please list below:
Does your agency maintain a mailing list?

Yes No

If yes, can it be sorted by a computer?

Yes No

Estimated Number of households:
Do you have a newsletter?

Yes No

If yes, how many times a year?
Does your agency sell groups?

Yes No

If yes, how many per year?
What is the size range for your groups in number of guests?
From
to
Does your agency sell MICE (Meetings, Incentive Travels, Conferences & Exhibitions) ?

Yes No

Your Name *:
Title *:
Date *: