[Please note that entry fields marked with an asterix (*) are required to be filled out for a prompt reply] T R A V E L . A G E N C Y . N A M E * T R A V E L . A G E N C Y . L I C E N S E * T Y P E . O F . O P E R A T I O N (Wholesale or Retail) N A M E * P O S I T I O N P O S T A L . A D D R E S S * C O U N T R Y * P O S T C O D E / Z I P C O D E * T E L E P H O N E * F A C S I M I L E e M A I L . A D D R E S S * Please send a copy of your brochure Yes No Please send me more information on (insert event or tour) Q U E S T I O N S / C O M M E N T S : Please provide us with a quotation on the following suggested itinerary: (include all relevant details eg. proposed dates of travel, number of travellers, places you would like to visit, standard of hotel required, etc.) Standard Of Hotel: Gold Silver Bronze Meals Required: All Meals | Breakfast | Lunch | Dinner Airport Transfers: Airport Bus Limousine Touring: Coach Day Tours Private Charter Any additional information: Please Note: In the case that you may be using a non-standard internet browser, some difficulty may be experienced when submitting this form. Should any difficulties arise, this form can be directly submitted to info@encounter-australia.com.au.