Please PRINT and complete the registration form below and our staff will contact you with your
User ID and Password after approval by carrier. A copy of this form MUST be completed
for each Carrier requested and payment in proper amount MUST
accompany this registration form.
City, State/Province, Postal Code and Country:
Full Name: ________________________________________
Carrier Organization Registering for:?
Org Number: _______________________________________
Access Fee: Standard of $50.00 for 3 months, payable in advance.
Non-refundable. Total Due $150.00, or (see
exception list) for alternate amount.
Please Check One of the Following:
____ Steamship Line/Conference
Connection Type, Check one:
____ Dial-up Modem 28k - 56k
____ Network/ISDN/Cable 128k+
Review our Privacy Statement
____ By checking this box I agree to the terms and conditions set forth and certify
that I have reviewed and understand the "tariff retrieval agreement".
____ I am authorized to enter my company into this agreement.