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GOGO NEW AGENCY REGISTRATION FORM

PLEASE PROVIDE ONE OF THE FOLLOWING NUMBERS:

* ARC#
* CLIA#
* IATA#
* TRUE#	If you do not have any of the above mentioned numbers, GOGO will assign you a pseudo booking number.
* TaxID#/SS#:	(a valid Tax ID/SS# is Mandatory)
* Manager First Name:
* Manager Last Name:
* Agency Name:
* Legal Name:
* Address: (NO P.O.BOXES)
* City:
* State:
* Zip Code:
* Email Address:
* Agency Telephone:
* Agency Fax:
* Incorporated?	Yes    No
*     Home-Based                                  StoreFront
* How did you hear about GOGO?:
Please complete this entire form and fax a copy of your ARC/CLIA, IATA, or TRUE certificate and W-9 form to 201-934-3764. All information is required; any omission will delay your activation process.
W-9 form can be downloaded here:  W-9