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Register Agency
Legal Company Name:
Doing Business as, if Different from above:
Check appropriate box: Individual/Sole Proprietor Corporation Partnership Other
Street Address:
City:
State/Province:
Country:
Postal Code:
Phone:
Toll Free Phone:
Fax:
Email:
Retype Email:
Web Page:

First Name: (President/Owner or General Manager)
Last Name: (President/Owner or General Manager)
User Name:
Password:

Enter your taxpayer identification numbers in the appropriate boxes. These must match the "Name" given above. For sole Proprietors your Federal EIN is your social security. This is for tax purposes.
State Tax Number: (This is a secured page. This informaiton will be protected and encrypted)

Enter your Activity Desk License if operating in the state of Hawaii, CLIA, IATA or OSN number(s) below in the appropriate boxes. These numbers must match the "Name" and "Address" provided above in order to authenticate.
AD License:
CLIA:
IATA:
OSN:

Online Booking Access: * Yes No (Are you requesting ability to book via the intranet site)
Website HTML Access: * Yes No (Are you requesting to widget to automate your website)
* Access subject to Activity Supplier's approval and completion of a Pono Rez User Agreement.