• By checking the following box I certify that I have read the terms and conditions relating to obtaining a New York City Virtual Presence and that I hereby agree to them.

   

• Please provide the following information:

  Name
  Title
  Organization
  Street Address
  Address (cont.)
  City
  State/Province
  Zip/Postal Code
  Country
  Phone
  E-mail
  Please indicate the Package you desire by placing a check mark in the box provided by clicking your mouse in the box.	Combination of Virtual Presence, 3 hours Conference Room Use and Telephone Services PACKAGE 1 ($175 per month)       A Manhattan mailing address and a shared fax number;  Mail and fax services; 3 hours of small or large conference room use per month. and discount rates for further use;  STANDARD Telephone Services PACKAGE 2 ($195 per month)       A Manhattan mailing address and a shared fax number;  Mail and fax services; 3 hours of small or large conference room use per month. and discount rates for further use;  PREMIUM Telephone Services Combination of Virtual Presence and 3 hours Conference Room Use Per Month PACKAGE 3 ($169.95 per month or, if you qualify for the small, new or non-profit discount $139.95 per month)   A Manhattan mailing address and a shared fax number;  Mail and fax services; 3 hours of LARGE conference room use per month. and discount rates for further use. PACKAGE 4 ($139.95 per month or, if you qualify for the small, new or non-profit discount, $119.95 per month)   A Manhattan mailing address and a shared fax number;  Mail and fax services; 3 hours of SMALL conference room use per month. and discount rates for further use;  Combination of Virtual Presence and Your Guarantee of Conference Room Use Per Month PACKAGE 5 ($449.95 per month or, if you qualify for the small, new or non-profit discount, $419.95 per month)   A Manhattan mailing address and a shared fax number;  Mail and fax services; $400 of conference room use per month. and discount rates for further use. PACKAGE 6 ($359.95 per month or, if you qualify for the small, new or non-profit discount, $329.95 per month)   A Manhattan mailing address and a shared fax number;  Mail and fax services; $300 of conference room use per month. and discount rates for further use. PACKAGE 7 ($269.95 per month or, if you qualify for the small, new or non-profit discount, $229.95 per month)   A Manhattan mailing address and a shared fax number;  Mail and fax services; $200 of conference room use per month. and discount rates for further use.

• Please provide the following payment information:

  Credit Card	VISA MasterCard American Express
  Cardholder Name
  Card Number
  Expiration Date
  CVV2/CVC2 Number*

*YOUR CVV@/CVC2 Number:  Visa and Mastercard, the three additional digits on the back of the card  printed on or just above the signature panel in reverse italics on the back of your card. Sometimes it is preceded by your card number. DO NOT CONFUSE THESE WITH THE LAST DIGITS OF YOUR CREDIT CARD NUMBER.  Amex cards, the four additional digits on the front of the card just above your credit card number

• Please enter the date you wish your New York City Virtual Presence to begin :

  -- mm/dd/yy
   

• If the Package you selected includes telephone services, please provide the following information:
  
  

  Firm Name:
  Contact Name:
  The Firm Name and Contact Name are pronounced like this:
  Fax Number:
  E-mail address:
  Answer my line like this:
  Here is the information I wish collected from my callers:	Name    Address    Telephone Number    Other (please specify)
  Type of business or profession:
  Office hours (Monday-Friday)
  Office hours (Saturday)
  Office hours (Sunday)
  Send my messages to me:	to my e-mail address         (US only) to my fax number
  Send me my messages at the following approximate New York City time (Monday or Friday) (Choose one)
  Here are some names callers may ask for:
  Here are some special instructions about calls:
  Here is some more information about me or my company: