Customer Sign-up Form

Today's Date:
TYPE of SERVICE ( check appropriate box )
	QuickLinx™-AUTOMATED CONFERENCING, PERMANENT 800 NUMBER AND PIN
	WebLinx™-POWERPOINT PRESENTATION CAPABILITY DURING A QuickLinx™
	OPERATOR ASSISTED-OPERATOR IS LIVE ON THE CALL
	30-day FREE TRIALl WEB CONFERENCING with purchace of audio
Company Name:
Primary Contact (PC):
Billing Contact:
Billing Address:
City:	State: Zip:
Phone:	Fax:
PC's e-Mail Address: ( very important )
DATE of FIRST CALL:
	How did you hear about Globalinx Communications?

You will be notified via e-mail when your account has been established.
QUESTIONS? CALL 630-717-8773