Subscription Form

Please complete all items and fax, mail or submit this form.

  Fax to: (727) 581-3725 or
Mail to:  StafTrack, Inc.
               P.O. Box 1133
               Largo, FL 34649


Owner/Manager Name
Primary Operator Name
Organization Name

        Send Invoice to Attention:

             Estimate Volume:

Please provide the following computer system information:

System Type: IBM PC MS-DOS Competable.,  Make/Model:
                        ZUES 1.3X      ZEUS 3, 4                Other:

Modem Type:   Hayes     US Robotics            Other:
Windows Only:
Yes          No

Baud Rate:          2400   14.4  28.8  33.6   56k     Other:

Printer Type:  Model:

   I do not have a computer available.  Please set up via phone, mail or fax.

I certify that I have read, understand, and agree to the terms and conditions

described in the StafTrack Subscription agreement and the attached Membership

Agreement, Arkansas, Georgia and Washington agreements (available on request).

I hereby acknowledge receipt of a copy of the above referenced information.

Authorized Signature:                                            

Name (Printed):                                                  

Date:                      Title:                   

Please complete all items and return this form via submit, fax or mail.

Fax - (727)581-3725 Mail: PO Box 1133, Largo, FL  34649

Please call our offices if you have any questions.


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Copyright Douglas W. Johnston
Last revised: July 04, 2013