Order ADDSecure.Net Inc. Services

Order ADDSecure.Net Inc. Services
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Organization/Contact information
Your Name (First Last)
Position
Your primary function
Canadian Government or Canadian registered non-profit organization
Organization
Department/Mail Stop
Email address
Your organization's principal Web site
Telephone (with country and area code)
Fax (with country and area code)
Street
City
Country	Other
Province/State	Other
Zip/Postal Code
Your company's principal business
How did you hear about us?
Services ordered
Number of times to have the service in the next year?
Preferred Payment Method
Credit card -- insecure Internet transmission Credit card -- fax or surface mail Send cheque by courier International Money Order (attached) Government Purchase Order Purchase Order
Preferred Report Delivery Method
Email me back PGP-encrypted .rtf attachment Email me back zipped .rtf attachment, use as a password ADDSecure.Net Inc. Contract Number Fax to my attention Surface mail me your printed report Other delivery method (specify)
ADDSecure.Net Inc. Authorized Reseller
Company or individual's name
Reseller's email address
Questions/Other relevant information