Travel Agent Program Information Request Form:


Select the items that apply, tell us about your agency
and then let us know how to contact you.

I currently have the following demographics regarding my business:
Agency Independent Agent
Corporate Clients Corporate Clients
Leisure Clients Leisure Clients

Please set up a corporate account for me and bill all net charges
to one of the following credit cards that is either
in my name or my company name when booking all of my requests
for clients:

Visa Mastercard America Express
Diners Club Discover Check/Debit


Credit Card #: Exp:
Name On Credit Card:
Billing Address:
City:
State: Zip:
Telephone:

(NOTE: Information provided must match the billing information on file with the financial institution issuing your credit card, in order for charges to be approved.)

Advance Electronic Check  
Bank Routing #:
Payment
Checking Acct #: Check #:
(NOTE: You will always receive a confirmation check from us for your records relating to any transaction of this nature)

I will always provide my clients credit card at the time of booking their request for the gross charges and will await my check from CSIINTERNATIONAL for my commissions on a monthly basis.
Please describe your business and any other information that would be helpful for our staff in the booking of the requests for your clients.



Name
Title
Agency
Address & Fax
Information
E-mail
Phone