Reseller/Travel Agent Application
Business Information
Business Name
*
Business Website
Business URL
Business Type
*
Business Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
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Colorado
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Delaware
District of Columbia
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State
Zip Code
Contact Name
*
First Name
Last Name
Contact Title/Position
*
Contact Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Reseller Package Selection
Please select Reseller Packages available
*
Reseller Basic
Reseller Plus
Reseller/Travel Agent
Request bi-monthly comission payout
I would like to request for bi-monthly comission payouts
Reseller Criteria Confirmation
Criteria Confirmation
*
I certify that my place of business can meet all criteria required for the applicable selected packages.
Reseller Acknowledgment
*
I certify that the above named business reflects the general intent and correct information to proceed forward to conduct busines with eTrekAdventures Sedona LLC. Further details will be made in the actual Agreement between parties, this form serves as an application only.
Please verify that you are human
*
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