New Wholesaler Form

Business Information

Business Name (required):

Business Main Operation (required):

Business Byline/Slogan:

Business Phone (required):

Business Fax:

Business Email (required):

Business Website URL:

Business Description (required):

Business Long Description (required):

Additional Business Information:

Company brochure which includes Australia:

Australian content in brochure:

Month of brochure production:

Approximate passengers to Australia per year:

Inbound tour operator:

Preferred Consortia:

Submitting Person's Contact Info

Submitting Person's Name (required):

Submitting Person's Email (required):

Business Contact Information

Name Of Primary Contact (required):

Primary Contact Title:

Primary Contact Specialty:

Primary Contact Phone (required):

Primary Contact Email (required):

Primary Contact Additional Info:

Name Of Additional Contact (required):

Additional Contact Title:

Additional Contact Specialty:

Additional Contact Phone (required):

Additional Contact Email (required):

Additional Contact Additional Info:

Other Notes, Comments, Requests: