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Virtual Office Secure Order Form Application
I have read and agree to the terms of service
*Agree to the Terms of Service
Yes
No
*Your Digital SignatureType your name
Customer E-Mail
Important: Enter a valid e-mail address. Your email address will be your account number.
*E-Mail:
Virtual Office Service
*Virtual Office Service:
*Initial Account Funds
*Your Name
*Company Name
*Years in Business
*Nature of BusinessMUST be specific.
*Website: http://If none,type none
*Mail Forwarding Frequency
Daily
Weekly
Monthly
Mail Forwarding Information
*First Name:
Middle Initial:
*Last Name:
Company Name
*Address Line 1:
Address Line 2:
Address Line 3:
*City
State / Province:
*Country
*Postal Code / Zip Code:
*Actual Contact Phone Number:Not Voice Mail
Virtual Office Add-Ons
License Hang
Mail Notification
Phone and Fax Service - Your own Manhattan 212 Phone or Fax Number
Manhattan 212 Phone
Add Professional Greeting Recording:
Add Email Forwarding of Voice Messages:
Manhattan 212 Fax
Add Email Forwarding of Faxes
Promotional Code
Enter your code:
Grand Total
Grand Total:
Billing Information
*First Name:Same name as on your card
Middle Initial:
*Last Name:
*Address Line 1:Where your statement is mailed
Address Line 2:
Address Line 3:
*City:
State / Province
*Country:
*Postal Code / Zip Code:
*Billing Phone Number:
Credit/Debit Card Information
*Credit Card Type
*Card Number:No dashes or spaces please
*Expiration Month:From your card
*Expiration Year:From your card
*CVV2:
Reset