EDFAX Technology Co., Ltd.-FaxSav for Internet Off-line Registration Form
Please print and fill out the following form then fax it to 1-714-242-1541

        Your name:_____________________________________________________ ( )Mr.( )Ms.

Organization name:_______________________________________________________ (OPTIONAL)

   Street address:__________________________________________________________________

             City:_______________________________________ State/Province:___________

  Zip/postal code:___________________Country:_______________________________________

   Area/City code:______Phone:_____________________ Facsimile:______________________

 Email addresses*:__________________________________________________________________ 

Please make sure your email address exactly matches that which is found in the "From:" line when sending email. If you are unsure of your exact email address, please send an email to checkmyaddress@edfax.com. You will receive an email with the correct address used with FaxMailer. If the exact email address returned by the automatic address checking feature is different than your standard email address, be sure to add it as an Alternate email address below. * You can write additional email addresses on a separate sheet and fax it along with this sheet.

Alternate email addresses (limited to 10):
If you would like to register other email addresses for your personal or corporate use, please enter each address below. NOTE: For individual use only. Billing will NOT subtotal these alternate email addresses.

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However, if you would like to set up a Corporate Account for multiple users AND receive detailed billing per email address see the following:
-Accounts with LESS THAN 50 email addresses: Register each email address individually with the same credit card number.
-Accounts with MORE THAN 50 email addresses: Please email your request with a list of email addresses and contact information to support@edfax.com for bulk loading within one week of receipt. For timeliness, please submit email addresses individually.

Alternative DELIVERY NOTICE email address:
As a default, FaxSav returns a Delivery Notice or Non-Delivery Notice to the same email address that originated the fax. However, if you would like a single email address other than that which originated the fax to receive all delivery notices please enter below.

___________________________________________________________________________

Credit Information

Type of Credit Card:  (  ) Visa  (  ) Mastercard   (  ) American Express

Name as it appears on card:______________________________________________________
      
Credit card number:___________________________________ Expiration date: ____-____

Please choose a password to use for this service. Keep your password written down some place in case you forget it.Your password must be 6 letters and/or numbers and will be upper and lower case sensitive: __________________

How did you hear about our service?
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Agent Code: TZ00000   (for official use only)