User Registration Request Form


How did you hear about us?
Enter Your Preffered Username:
Enter Your Preferred Password:

Name *:
Company Name:
Company Address:
City:
State Or Country:
Zip Code:
Phone *:
Fax:
Email Address *:
When is the best time to call?
PLATFORM: (check all that apply)
Host:	iSeries/400 UNIX SYS/36 Other(specify)
Network:	NT Novell Other(specify)
FAXING NEEDS
What do you plan to fax from?
What do you plan to fax?	Invoices Orders Order Confirmations General Correspondence Other(specify)
How many pages do you plan to fax per day?
How many fax machines and/or fax modems do you currently utilize?
Do you plan to recieve faxes?	Yes No
DATA MINING NEEDS
Are you interested in our data mining tool IntelliJade?	Yes No
Alternate Contact Information:
Name:
Title:
Phone Number:
Fax Number:
Email Address:

PLATFORM: (check all that apply)