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REGISTER YOUR CORPORATION

* Important

a) Please complete every highlighted box which are mandatory
b) Please do not use the same email address for different people - it is neccesary for each person to have a different e-mail address
c) All usernames and passwords are case-sensitive

Name of Merchant, Supplier or Service Provider:
Registered Name in full:
Registered Business Name:
Nature of Business:

Head Office Address:
Street Address:
City:
Postal Code:
Province:
Country:
Telephone:
Telefax:

Email address:
Email address to where Tell Oscar comments are to be sent
Corporation's Website:

First Name of person dealing with your answers on Tell Oscar:
Last Name of person dealing with your answers on Tell Oscar:
This person's direct telephone number:
This person's cellphone number:
This person's username on Tell Oscar:
Password:
Confirm Password:
This person's Email address:

First Name of back-up dealing with your answers on Tell Oscar:
Last Name of back-up dealing with your answers on Tell Oscar:
This person's direct telephone number:
This person's cellphone number:
This person's username on Tell Oscar:
Password:
Confirm Password:
This person's Email address:

Name of Chief Executive Officer:
Email address for this person:
Name of Manager
Email address for this person:

On behalf of the above, I hereby apply to be a corporate member who answers on TellOscar.com and confirm and warrant that I am duly authorized to do. On behalf of the Corporation, I confirm that we have read, understood and accepted the disclaimers and further terms and conditions. Should we accept your quotation and should we be accepted by yourselves as a Corporate who Answers on TellOscar.com, we agree to pay the annual registration fee and any further annual fee as determined in your quotation to us.

Signature: ____________________________
Name:
Capacity:
Telephone:

By checking this box, I acknowledge the correctness of the above: