• 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
  If you desire telephone services  (to see Details below please indicate  by placing a check in the box by   inserting  your cursor in the box and left   clicking your mouse	Standard Telephone Answering Premium Telephone Answering Voicemail  Call Forwarding  Number to which calls are to be forwarded
  If you are a Small Business/New Business  to enjoy the Special Monthly Rate please place a check in the box by   inserting  your cursor in the box and left   clicking your mouse

• Please provide the following payment information:

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

*YOUR CVV2/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 you desire 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: