AIR MOLDOVA :: Application form for corporate members

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Application form for corporate members

Application form for corporate members

All fields are required. In case of no data insert a through-line please. Write down your surname, name and additional name the same way as it is written in your international passport.

Corporation

COMPANY NAME:

BUSINESS TYPE:

CORPORATION ADDRESS:

E-MAIL:

PHONE NUMBER:

FAX:

Responsible person for correct use of the accumulated Credit Miles

NAME:

SURNAME:

ADDITIONAL NAME:

PHONE NUMBER:

PLEASE NOTE THE LANGUAGE YOU WOULD LIKE TO RECEIVE INFORMATION ABOUT ACCOUNT: Româna English Русский

Date:

QUANTITY OF MEMBERS:

List of staff members

Member #1

NAME:

SURNAME:

ADDITIONAL NAME:

PASSPORT NUMBER:

DATE OF BIRTH:

I AGREE TO ABIDE BY THE AIR MOLDOVA CLUB TERMS AND CONDITIONS

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