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 Telephone FAX E-mail
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:
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.
(727)581-3603
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