PS PhiLGEPS TRAVEL TICKETING REGISTRATION FORM

Note: Asterisk (*) indicates mandatory fields

ORGANIZATION INFORMATION

Organization Name * : _____________________________________________________________________________

Agency Tax Identification Number* : -

ORGANIZATION ADDRESS:

Address* : _____________________________________________________________________________

Province* : _____________________________________________________________________________

City/Municipality* : _____________________________________________________________________________

Zip Code* : _________

Agency Account Code* : Credit Limit* : ____________________________

AUTHORIZED CONTACTS

PRIMARY CORPORATE ADMINISTRATOR (Manages accounts of the Agency)

Salutation Title* : Mr. Ms.

First Name* : _________________ Middle Name : ______________ Last Name *: _____________________

Phone No.* : ______ - ______ - ______ Loc: ________ (e.g. 632-999-9999 Loc. 133)

Fax No. : ______ - ______ - ______ (e.g. 632-999-9999)

Email Address* : ______________________________ (e.g. buyer@philgeps.gov.ph)

_______________________
SIGNATURE
TRAVEL ARRANGER (Books / pays ticket for the Agency)

Salutation Title: : Mr. Ms.

First Name* : _________________ Middle Name : ______________ Last Name *: _____________________

Phone No.* : ______ - ______ - ______ Loc.: ________ (e.g. 632-999-9999 Loc. 133)

Fax No. : ______ - ______ - ______ (e.g. 632-999-9999)

Email Address* : ______________________________ (e.g. buyer@philgeps.gov.ph)

_______________________
SIGNATURE

URL of Agency logo : _____________________________________________ (e.g. http://www.philgeps.gov.ph/logo.jpg)

Authorized by:

___________________________
HEAD of the AGENCY

RR Road Cristobal Street, Paco, Manila, Philippines 1007 Tel. Nos. 6897750 loc.4030/5621903|
Fax5616094
PhilGEPS- Unit 608 Raffles Corporate Center, F. Ortigas Jr. Road., Ortigas Center, Pasig City 6406900 loc.8302-
8313/640905|Fax6406911