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Tarvel Agent Registrations Form
To receive commissions, please read and complete ALL sections below.
Documents 1, 2, and 3 are required. Please send
1. this form with your signature as certification,
2. a copy of your IATA or CLIA certificate, and
3. a completed Form W-9 or Form W-8 from the US IRS to the address above to receive commissions from Chivalry Limousine LLC. You may also include
4. a list of reservations and dates of service in need of commission payment (OPTIONAL)
Travel Agent
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Name: _________________________________________________ |
Date:_____________________________ |
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Phone Number:__________________________________________ |
Fax:______________________________ |
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E-mail:_____________________________________________________________________________________________ |
Travel Agency
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ARC/IATA/CLIA No:________________________________________ |
Phone Number:______________________ |
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Agency Name:_______________________________________________________________________________________ |
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Street Address: ______________________________________________________________________________________ |
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City: _______________________________________________________________________________________________ |
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State:___________________________________________________ |
ZIP Code:___________________________ |
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Country:____________________________________________________________________________________________ |
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E-mail:______________________________________________________________________________________________ |
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After ALL required documents have been received, please allow three (3) business days for processing. For any inquiries, please call +1-203-502-6652.Fax Completed Documents to +1-203-502-6659
Certification
All of the information that I have provided on this form is correct to the best of my knowledge and I am authorized to submit this registration form. I understand that this application is subject to approval. I authorize Chivalry Limousine LLC. to make any inquiries that it considers appropriate to determine if it should pay me commissions. This may include verification of employment. I acknowledge and accept the terms and conditions posted on Chivalry Limousine LLS's Web site at www.chivalrylimo.com
Signature:________________________________________ |
Date:________________________________ |
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