Online Registration Center - Service Application

The information provided below will be used to prepare a license agreement. This information will not be distributed to any third parties, and will not be kept online. If you have any questions about the information requested below, please feel free to contact us directly.
Merchant Information:
Company Name  * Postal Code
Contact Name  * Country
Position Phone  *
Address  * Fax
City Email  *
State/Province Web Site
How did you hear about OnlineRegistrationCenter.com? 
Search engine? what key words did you use?

Desired Package:

 Standard
 Advanced
 Enterprise
 Combination
Event Registration Type:
Training Course Seminar Conference
Distance Learning Membership Soft Goods
Other:
Transaction & Tax Information:
Expected Transaction Amount
Expected Transactions/Month
Federal Tax ID
Merchant authorizes the ORC to investigate and confirm the information contained herein and hereby certifies that all the information provided, including Merchant's legal status, is true, correct, and complete. Merchant hereby authorizes the ORC to utilize credit bureau/reporting agencies and /or its own agents for purposes of verifying the accuracy of any information provided by Merchant and for purposes of accessing and monitoring Merchant's credit status. Merchant authorizes all such credit bureau reporting agencies to release any information they may have pertaining to Merchant to the ORC. This Merchant Application may only be modified as approved in writing by an authorized officer of the ORC/BIZNET Internet Services, Inc.

By agreeing to this Merchant Application, I acknowledge that the above information is correct and that I understand the terms as stated above.
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