Account Number:
Agency Name:*
Street Address:*
City/Town:*
State/Provence:*
Zip/Postal Code:*
Country:*
Agency IATA Number:*
Agency Phone Number:*
24Hrs.Number (if available):
Agency Fax Number:
Agency Email Address:*
Contact Name:*
Contact Title:*
Contact Phone Number:*
Contact Mobile Phone Number:
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Comments
Yes, I have read and agreed with the Travel Agents Terms & Conditions of Diplomat Limousine Service LLC.*
Please note that approver must be an officer or authorized agent legally able to bind the Company.
E-signature:*
By typing your name in the above box and submitting this application electronically you are certifying that the above listed information is correct and you have read and agreed with the Travel Agent Terms & Conditions published on Diplomat Limousine Service LLC. website. Also authorizing Diplomat Limousine Service LLC. to verify the above information anytime if needed.
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Date:*
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