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NAME/ COMPANY NAME: *
CONTACT NAME: *
PRIMARY LANGUAGE: *
ADDRESS: *
CITY: *
POSTAL/ZIP CODE: *
COUNTRY: *
TELEPHONE: *
FAX:
E-MAIL: *
WEBSITE:
WHERE DID YOU HEAR ABOUT US: *
YOUR CURRENT BUSINESS: (please describe) *
WHAT IS YOUR MARKET AREA?: *
NUMBER OF EMPLOYEES: *
GENERAL COMMENTS:
NAME AND POSITION: *
MSN/YAHOO ID:
DO YOU WANT TO OPEN TEST ACCOUNT WITH US?:	Yes No
DO YOU HAVE YOUR OWN SIP/H323 SERVER/GATEWAY:	Yes No
YOU’RE SIP/H323 SERVER/GATEWAY IP ADDRESS:
PROTOCOL:
CODEC:
DO YOU HAVE YOUR OWN BILLING SOFTWARE?:	Yes No
YOU’RE SOFTWARE IOS VERSION?:
TECH PREFIX (IF REQUIRED):
SERVICES YOU WANT TO TEST (DIRECT IP to IP, PC2Phone, Device2Phone, Calling Card and CallBack):
MINUTES PER WEEK?: