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Company's Name Contact Name Mailing address How would you like us to contact you? Phone E-mail Contact phone number Business Ph#:  E-mail address Best time to contact What type of Operating System do you have W'XP              W'98              W'00           Mac   NT                W3.1              W'95            Other Do you need software? Yes         No   Username choices: (this will be your e-mail address) 1.                                   2.           3.                                   4. Password:(6 characters- can be changed after initial login) Billing: E-mail           Credit Card Number of employees on-line What is the nature of your business? Comments: