// Available post fields: // name: Reseller name // ctor: Reseller ID // logo_url: URL to reseller's logo from a secure server. ?>
} else { if ($logo_url) { echo "
"; } } ?>
Complete the registration form below. Please have a credit card or check available for payment of the registration fee. if (!$ctor) { ?> If you would prefer to lease (rather than purchase) your registration, please click here to register. } ?> All fields are required. Click the PROCESS AND CONTINUE button at the bottom of the form when completed. For questions, please call iTransact at (801) 298-1212. |
How did you hear about us? | |
Business Name: (If no business name, enter your name.) |
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First Name: | Last Name:
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Title: | |
Address: | |
City: | State:
Zip:
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Country: | |
Web Site URL: | |
Contact Phone Number: | |
Customer Service Phone: | |
Fax Number: |
2. EMAIL INFORMATION |
General Contact Email: | |
Email for Orders: | |
Email for Order Form Errors: | |
Send Order Confirmation Emails To Customers?: |
Password: | |
Verify Password: |
4. REGISTRATION FEE PAYMENT |
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Select one of the following options for payment of the registration fee. This information will be used for payment of the registration fee and monthly fees. Monthly fees are debited the first week of each month beginning the first calendar month after your registration. | |
The total amount charged to your credit card or checking account will be shown on the next page
under the
"fees" section. Your account information will not be stored or used until after you have submitted the agreement form on the
next page. (See the prices page for complete details.) |
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How will you be paying the registration fee? |
Credit Card Check |
CREDIT CARD INFORMATION |
Credit Card Number: | |
Expiration Date: | |
Address on Card Statement: | |
Zip on Card Statement: |
CHECKING ACCOUNT INFORMATION |
THIS INFORMATION MUST BE FROM A CHECK, NOT FROM A DEPOSIT TICKET. | Nine digit ABA number: | |
Your account number: | ||
Please note that payment of your registration fee by check will delay the setup of your account. We must wait for funds to clear your bank. | ||
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