HOW TO REGISTER WITH US FOR A WEB PAGE
If you would prefer to use this form, please print and fax
to 908-272-6297

 E A S Y  *  W E BŪ    R E G I S T R A T I O N     F O R M
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
NAME:
COMPANY NAME:
ADDRESS LINE 1:
ADDRESS LINE 2:
CITY:
STATE:
ZIP:
YOUR TITLE:
REQUESTED WEB SITE NAME:
(of the form "www.NAME.com")
ALTERNATE SITE NAME:
2ND ALTERNATE SITE NAME:

SITE DESCRIPTION (30 WORDS):


YOUR PHONE:
YOUR FAX:
YOUR EMAIL ADDRESS:
TODAY'S DATE:

DON'T FORGET TO

Any problems: Call us at 1-888-ASK-CSS1 or (908) 272-0016. We'll be glad to assist you over the phone.


Copyright © 1996-2000 CompAmerica Internet Services Company. All Rights Reserved.
"EASY*WEB" is a usemark of the compamericadirect.com. It may not be used by any third party without the express permission of its owner.