Step 3. Fill out and submit the form to advancis (all information is required).

 PERSONAL INFORMATION

Note: advancis customers who do not wish to enter new information can simply provide their customer number. Our staff will complete your order form using the data (including PIN and password) provided during your previous order(s).

Last Name First name
Title Company
Address
City Province
Postal code Country
Email Web site
Phone Fax
Customer number    

 WEB SITE INFORMATION

Web site address



Customer affirms that he/she is either (1) the legal owner of the aforementioned web site ("the web site"), (2) an employee of the legal owner of the web site, or (3) has obtained express written permission from the legal owner of the the web site for use of the e-business First-aid kit Service in testing the web site. Customer expressly agrees to indemnify advancis.com from any claims by a third party arising from use of the Service in testing the web site.

 TERMS AND CONDITIONS

Please read carefully the Terms and Conditions governing the use of the e-business First-aid kit.


I have read and agree to the Terms and Conditions of use

 IDENTIFICATION

Please select a PIN and password to access restricted sections of the advancis.com web site. Choose 3 to 8 characters, using only A-Z, a-z, and 0-9. Write it down for your records. Note: current customers do not have to enter a new PIN or password.

PIN Password


 PAYMENT INFORMATION

The fee for the e-business First-aid Kit is US $429/year.

Credit card  


  Credit card number  
  Cardholder's name  
  Expiration date  
  Card verification number Click on icon for details
  Issuing bank