Account Application for Web-based Order Processing Service

Open an Account

To apply for an account, please complete this form and press the Submit button at the end of the page.

Required fields are noted with an *

I have read and agree to the service terms

*	Your Name:
	Company:
*	Address:
*	City:
*	State:	Zip:
*	Telephone:	- -
*	EMail:
*	I access the internet from a Windows PC:	yes no	About Windows
*	I access the internet through:		About Internet Access

*	Describe the product(s) you plan to sell:

*	Expected number of orders per month:
*	Your domain name: www.	About Domain
*	URL for your logo:	About Logo
*	Your Bank Name:	About Your Bank
*	Name on Account:
*	Bank Account Nbr:
*	Bank Route Nbr:

*	Will you accept payment by check? yes no	About Payment Methods
*	Will you accept orders from Canada? yes no	About Foreign Orders
*	Will you accept orders from all Other countries? yes no

*	Address for Payments:

May we include a link to your site from ours? yes no

PFK Systems, Inc