Fax Application
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PLEASE PRINT A
COPY OF THIS PAGE. ALL OF THE INFORMATION MUST BE COMPLETED FOR YOUR VSA SUBSCRIPTION APPLICATION TO BE PROCESSED. PLEASE FAX YOUR COMPLETED APPLICATION TO 1-512-857-0880. REMEMBER, THE FIRST 30 DAYS ARE FREE!
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| 1. |
Personal
Information |
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Your
Name: (Required):_______________________________________________________
E-Mail Address (Required):_____________________________________________________
Company Affiliation:___________________________________________________________
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Telephone
No. (Required): (_____)______________ Fax No.:
(_____)________________ |
| 2. |
If
your company is sponsoring your subscription, enter your company code.
Complete company and association discount
information can be found online at http://vsa.fsonline.com/vsap/discounts.html
Company Code:____________
(Your company or association discounted subscription fee will be confirmed
in the enrollment e-mail you are sent)
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| 3. |
Request
Username and Password: You may use letters and/or numbers, but
keep them simple and between 1 and 8 characters: |
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Username:
1st Choice: ________________ 2nd Choice: _______________ |
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Password:
1st Choice: ________________ 2nd Choice: _______________ |
| 4. |
Credit
Card Information: ____Visa ____Mastercard
____American Express |
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Name
that appears on card: __________________________________________________ |
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Credit
Card Number: ____________________________________ Exp. Date: _____/_____ |
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Credit
Card Billing Address-- Street: ____________________________________________ |
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City,
State, Zip: ____________________________________________________________ |
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In signing below,
you authorize FSO/VSA to charge the monthly VSA subscription fee to your
credit card unless you cancel your subscription prior to end of your "free
look," as explained in Subscriber Services. |
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Signature:
_________________________________________________________________ |
Your VSA Subscription Application will be processed within 8 business hours
of its receipt via fax at 1-512-857-0880. You will then be sent an e-mail
confirming your VSA Username and Password. Your password should be kept
confidential. This enrollment e-mail will also confirm the monthly subscription
fee that will be billed to your credit card if you do not cancel
your subscription during the first 30 days.
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