Maxislands

Registration for Travel Agent Affiliate Programme

Registration for Travel Agent Affiliate Programme
Contracting Party * :
Address * :
City
State
Country * :
Contact Name * :
Telephone * :
Fax
Email *
Website
VAT No. (EU States Only)
Bank Details
Account Holder Name *
Bankers *
Bankers Address *
Bank Account No. *
IBAN
Swift Code
Remarks / Comments : Characters Remaining : 250
Accounts Section contact (person responsible for revenue/income)
  Same As Above
Name * :
Email Address * :
Terms & Conditions   I have read and accept the terms and conditions
Enter Security Code Below : Security Code