Application Form – Travel AgentsTell us about you!Salutation:First Name:Last Name:Title:Email:Phone:Phone Extension:Will this be your first trip to Québec City?:If not, when was the last time?:Tell us about your business!Company name:Country:--None--CANADAUNITED STATESMEXICOAFGHANISTANÅLAND ISLANDSALBANIAALGERIAAMERICAN SAMOAANDORRAANGOLAANGUILLAANTARCTICAANTIGUA AND BARBUDAARGENTINAARMENIAARUBAAUSTRALIAAUSTRIAAZERBAIJANBAHAMASBAHRAINBANGLADESHBARBADOSBELARUSBELGIUMBELIZEBENINBERMUDABHUTANBOLIVIA, PLURINATIONAL STATE OFBOSNIA AND HERZEGOVINABOTSWANABOUVET ISLANDBRAZILBRUNEI DARUSSALAMBULGARIABURKINA FASOBURUNDICAMBODIACAMEROONCAPE VERDECARAÏBES NÉERLANDAISESCAYMAN ISLANDSCENTRAL AFRICAN REPUBLICCHADCHILECHINACHRISTMAS ISLANDCOCOS (KEELING) ISLANDSCOLOMBIACOMOROSCONGOCONGO, THE DEMOCRATIC REPUBLIC OF THECOOK ISLANDSCOSTA RICACÔTE D'IVOIRECROATIACUBACURACAOCYPRUSCZECH REPUBLICDENMARKDJIBOUTIDOMINICADOMINICAN REPUBLICECUADOREGYPTEL SALVADOREQUATORIAL GUINEAERITREAESTONIAETHIOPIAFALKLAND ISLANDS (MALVINAS)FAROE ISLANDSFIJIFINLANDFRANCEFRENCH GUIANAFRENCH POLYNESIAFRENCH SOUTHERN TERRITORIESGABONGAMBIAGEORGIAGERMANYGHANAGIBRALTARGREECEGREENLANDGRENADAGUADELOUPEGUAMGUATEMALAGUERNSEYGUINEAGUINEA-BISSAUGUYANAHAITIHEARD ISLAND AND MCDONALD ISLANDSHOLY SEE (VATICAN CITY STATE)HONDURASHONG KONGHUNGARYICELANDINDIAINDONESIAIRAN, ISLAMIC REPUBLIC OFIRAQIRELANDISLE OF MANISRAELITALYJAMAICAJAPANJERSEYJORDANKAZAKHSTANKENYAKIRIBATIKOREA, DEMOCRATIC PEOPLE'S REPUBLIC OFKOREA, REPUBLIC OFKUWAITKYRGYZSTANLAO PEOPLE'S DEMOCRATIC REPUBLICLATVIALEBANONLESOTHOLIBERIALIBYAN ARAB JAMAHIRIYALIECHTENSTEINLITHUANIALUXEMBOURGMACAOMACEDONIA, THE FORMER YUGOSLAV REPUBLIC OFMADAGASCARMALAWIMALAYSIAMALDIVESMALIMALTAMARSHALL ISLANDSMARTINIQUEMAURITANIAMAURITIUSMAYOTTEMICRONESIA, FEDERATED STATES OFMOLDOVA, REPUBLIC OFMONACOMONGOLIAMONTENEGROMONTSERRATMOROCCOMOZAMBIQUEMYANMARNAMIBIANAURUNEPALNETHERLANDSNEW CALEDONIANEW ZEALANDNICARAGUANIGERNIGERIANIUENORFOLK ISLANDNORTHERN MARIANA ISLANDSNORWAYOMANPAKISTANPALAUPALESTINIAN TERRITORY, OCCUPIEDPANAMAPAPUA NEW GUINEAPARAGUAYPERUPHILIPPINESPITCAIRNPOLANDPORTUGALPUERTO RICOQATARRÉUNIONROMANIARUSSIAN FEDERATIONRWANDASABASAINT BARTHÉLEMYSAINT HELENASAINT KITTS AND NEVISSAINT LUCIASAINT MARTINSAINT PIERRE AND MIQUELONSAINT VINCENT AND THE GRENADINESSAMOASAN MARINOSAO TOME AND PRINCIPESAUDI ARABIASENEGALSERBIESEYCHELLESSIERRA LEONESINGAPORESLOVAKIASLOVENIASOLOMON ISLANDSSOMALIASOUTH AFRICASPAINSRI LANKAST. CROIXSUDANSURINAMESVALBARD AND JAN MAYENSWAZILANDSWEDENSWITZERLANDSYRIAN ARAB REPUBLICTAIWAN, PROVINCE OF CHINATAJIKISTANTANZANIA, UNITED REPUBLIC OFTHAILANDTIMOR-LESTETOGOTOKELAUTONGATRINIDAD AND TOBAGOTUNISIATURKEYTURKMENISTANTURKS AND CAICOS ISLANDSTUVALUUGANDAUKRAINEUNITED ARAB EMIRATESUNITED KINGDOMUNITED STATES MINOR OUTLYING ISLANDSURUGUAYUZBEKISTANVANUATUVENEZUELA, BOLIVARIAN REPUBLIC OFVIET NAMVIRGIN ISLANDS, BRITISHVIRGIN ISLANDS, U.S.WALLIS AND FUTUNAWESTERN SAHARAYEMENZAMBIAZIMBABWEAddress:Address - Line 2:Address - Line 3:City:Province / State:--None--** - **AB - AlbertaACT - Australian Capital TerritoryAK - AlaskaAL - AlabamaAR - ArkansasAZ - ArizonaBC - British ColumbiaCA - CaliforniaCE - CearáCO - ColoradoCT - ConnecticutDC - District of ColumbiaDE - DelawareFL - FloridaGA - GeorgiaHI - HawaiiIA - IowaID - IdahoIL - IllinoisIN - IndianaJBT - Jervis Bay TerritoryKS - KansasKY - KentuckyLA - LouisianaMA - MassachusettsMB - ManitobaMD - MarylandME - MaineMG - Minas GeraisMI - MichiganMN - MinnesotaMO - MissouriMS - MississippiMT - MontanaNB - New BrunswickNC - North CarolinaND - North DakotaNE - NebraskaNH - New HampshireNJ - New JerseyNL - Newfoundland and LabradorNM - New MexicoNS - Nova ScotiaNSW - New South WalesNT - Northern TerritoryNT - Northwest TerritoryNU - NunavutNV - NevadaNY - New YorkOH - OhioOK - OklahomaON - OntarioOR - OregonPA - PennsylvaniaPE - Prince Edward IslandPR - ParanáQC - QuébecQLD - QueenslandRI - Rhode IslandRJ - Rio de JaneiroRS - Rio Grande do SulSA - South AustraliaSAN - SantiagoSC - South CarolinaSD - South DakotaSK - SaskatchewanSP - São PauloTAS - TasmaniaTN - TennesseeTX - TexasUT - UtahVA - VirginiaVIC - VictoriaVT - VermontWA - WashingtonWA - Western AustraliaWI - WisconsinWV - West VirginiaWY - WyomingYT - YukonPostal code / Zip code:Website:Company Profile:Do you work with a receptive operator? If yes, which one:How many room nights did you sell last year in Québec City:Forcasted number of room nights next year:What are your clients looking for:When will you be visiting Québec City?What would you like to see during your visit:Arrival date in Québec City:Departure date:Travelling with a guest:Number of guests:Name of guests (included ages for children):Where will you be staying in Québec City:Please indicate full address:Confirmation number:Verification:Please enter the 4 character string shown in the box above. (Please enter the 4 character string shown in the box above.)Red fields are required.Envoyer Réinitialiser