Subscription Form

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: