| Travel CRM

Agent Registration Form

USER NAME *

COMPANY NAME *

COMPANY EMAIL ID *

EMAIL ID *

Password *

Confirm Password*

CONTACT NUMBER *

FAX NUMBER

Reference Person Email

COUNTRY *

CITY *

CORPORATE REG. NO

SKYPE ID

CORPORATE DESCRIPTION

ADDRESS LINE*

CERTIFICATE OF CORPORATION

CHOOSE CERTIFICATE

LOGO

CHOOSE LOGO

PROFILE

CHOOSE PROFILE

AGENT CURRENCY *

AGENT COUNTRY OF OPERATION *

SERVICE BANK DETAIL

ACCOUNT NUMBER

BANK NAME

BANK IFSC CODE

BANK IBAN CODE

Account Holder Name

CURRENCY

CONTACT PERSON

Designation*

Contact Person Name *

Phone *

WhatsApp Number *

EMAIL *