Form No.03-NRC
Dist – Acct
Rev – 2014 Dec 22
Net Rate Contact
(NRC)
Instructions
1.
2.
In order to get you set up in our system we need for you to provide us with the following information.
Please Type or Print Clearly.
The full name and title you would like us to address the Net Rate Agreement Contract to:
Full Legal Name of the
Company:
Street & Suite:
Company Address:
City/State/Zip:
Street & Suite:
Billing Address:
City/State/Zip:
Phone Number:
Emergency Contact
Phone Number:
(if issues occur during non
business hours)
Fax Number:
Email Address:
Name of individual responsible for
Name of OWNER
SIGNING THE CONTRACT
Contact Name:
Contact Name:
Title:
Title:
Telephone Number:
Telephone Number:
Email Address:
Email Address:
Name of individual responsible for
Name of individual to whom
RESERVATIONS
INVOICES need to be addressed
Contact Name:
Contact Name:
Title:
Title:
Telephone Number:
Telephone Number:
Email Address:
Email Address:
For CBCL Use Only
Date Received:
RT Fare Code:
Contact List Updated:
1W Fare Code:
Return via Fax to 954-414-1323 or email [email protected]
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