Store sign up form

Your Name/Name of Agency Contact *	First Last
Travel Agency Name *
Address *	Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone *
Form Enquiry Email *	Email to receive enquiries from
Your email address *	This is the email address we need to contact you about this entry if needed
Monday to Saturday Opening and Closing Times
Introductory Text about your Agency ( up to 150 words)
Page heading image - this should be 840 x 300 pixels wide ( or a larger rectangle image that we can resize for the page. Please make sure that you have permission to use the image.
Attach Store or other image
Attach another image if required