Customer Information

 Company Name :  .................................................................................................................................
 Email Address :  ....................................................................................................................................
 Full Name of responsible person:  ..........................................................................................................
 Address :  .............................................................................................................................................
 City :  ........................................................................................Post Code : ........................................
 Province : ..................................................................................Country :  ...........................................
 Telephone No's :  ..................................................................................................................................
 Fax No's :  ............................................................................................................................................

Status Report Setting

 Receive Receipt Mail :              ___  Yes        ___ No            (default: Yes is highly recommended)
 Receive Fax Result Report :      ___  Yes        ___ No            (default: Yes is highly recommended)
 Include E-mail Header  ( from, to, subject ) in the First Fax Page :          ___  Yes      ___  No

Client Program & Windows Configurations

 Microsoft Windows Version :  ___ 3.x       ___ 95           ___ 98   ___Win2000    ___WinXP
 Microsoft Internet Explorer Version :          ___ 5.00 or above      ___ Not Installed

 EBS Use only
 Account Number :

 Record Number : 

 Sales:

 SCL.

 Date: