Form Page 17

• Contact information:

•    Last name   

• First name   Middle initial 
     Organization 
    Street address 
   Address (cont.) 
              City 
    State/Province 
   Zip/Postal code 
           Country 
        Work Phone 
        Home Phone 
               FAX 
            E-mail 
• Account information:
• 
  Is your event Local Regional International?

  Is this the first year for this promotion? YesNo. If NO, give year last hosted 

  TicketTown will direct deposit your event receipts, ONCE WEEKLY to a bank account of your choice, if required at NO EXTRA CHARGE. Will you utilize TicketTown's FREE Direct Deposit Service? YesNo

  If Yes, complete the Banking details section below:

  Banking Details:

  Bank Name: Branch: Account Number:

  Account Name: User name Password 
  Confirm password 

• Vat Return:

TicketTown will prepare and file your VAT returns directly with the Comptroller of Customs - VAT Division, if required. Will you be utilzing this service? YesNo

If Yes, complete the VAT Return section below:

VAT Return:

Vat Registration Number:

Last Return Period Filed:

Do you consent to TicketTown promoting your event on its Website, Telephone Voice Menu System and its Event Calendar to be posted at each outlet? YesNo

How did you become aware of the Services offered by TicketTown?

Date
 
 

• ordering information:
• 
  Event Name ** 

  Venue Name **

  Date** : Yrmmdy Start Time ** AMPM

  Total Tickets required (including complementary):

  Ticket Breakdown: Paid Comps Total

  Price: $$$$$

  Category 

  Do you intend on using TicketTown's outlets as the exclusive Box Office

  for your event?YesNo

If No, please give full details in the comments section.
Comments:
 
 

                 SHIPPING
  Street address 
 Address (cont.) 
            City 
  State/Province 
 Zip/Postal code 
         Country