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New Agency Application |
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If your agency is not already registered, please fill out the form below and send in the requested paperwork. Once your information has been added, an email will be sent advising how to create a username and password. It takes up to 24 hours for an agency to become active in the system.
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Agency Name:
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Address:
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City:
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State:
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Zip:
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Owner's Name:
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*
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Manager's Name:
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| Phone Number (555-123-1234): |
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| Fax Number (555-123-1234): |
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| Email: |
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| Agency's Web Site (URL): |
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| ARC Accredited Number or CLIA: |
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Are you affiliated with a consortium?
If so, please indicate their name(s):
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How did you hear about us: |
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Travel Industry Background
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| Are you an independent or outside agent?: |
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Do you provide storefront access to your clients or are you a homebased agency?:
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*
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I hereby consent to receive facsimiles & e-mails of advertisements and promotions from Vacation Express and any of its travel partners:
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To complete your application
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In order to comply with Internal Revenue Service
requirements for Form W-9 information, we are
requesting your federal tax identification number.
IRS Code Section 6019, recipients payments are
required to provide federal tax indentification
numbers to payers. Section 6676 of the Code currently
provides for mandatory backup withholding of 31%
for failure to give an identification number to
a payer
(W-9 pdf).
Please also include a copy of your ARC accreditation letter or your CLIA certificate.
After saving your documents(W-9, ARC/CLIA Accreditation Certificate),
print, and fax completed forms with owner's signature to: 404-393-4828 or
mail completed forms with owner's signature to:
Vacation Expess, Attn:Sales, 3495 Piedmont Rd.
Bldg. 11 - STE. 400 Atlanta, GA. 30305.
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