VTECHLINK Fax/Mail Signup Form

[Items in bold are required information to complete the signup]:

Contact Person Name:                                                                         
Company Name:                                                            
Street Address1:                                                             
Street Address2:                                                             
City, State, Zip:                           ,                    ,               Country:                                        
Contact Phone:                                 Email:                                                     

Select VTECHLINK subscription service [Circle one]:

[For multiple accounts, contact us for custom volume discounts]

Enter credit card information:

Card Type [circle one]: Visa MasterCard  American Express  Diners Club
Name [as it appears on the card]:                                                              
Card Number:                                                               
Expiry Date:                  
Signature:                                 

Pick a username and password for your account for accessing the site [username and passwords are cASe SensiTiVe; max length - 8 characters]:

User Name:                                   Password:                

Either fax the completed form to us at [+1] 301-323-4088 or mail the completed form with a check for the applicable amount [make check payable to: V-TECH, inc] to:

VTECHLINK Subscription Service, P.O. Box 713, Glen Echo, MD 20812-0713, U.S.A.