Web Access Consignment International (WACI) Account Application Form

 _
|_| Check this box if you have read and agree
    to the WACI Terms Of Use




Your Account Information (* = required information, if applicable)


* Your First Name:             _____________________________________________

* Your Last Name:              _____________________________________________

* Your Email Name:             _____________________________________________

* Your Business Name:          _____________________________________________

* Your Business Phone:         (_____)______________________________________

* Your Business Address:       _____________________________________________

                               _____________________________________________

* Your City/Town:              _____________________________________________

* Your State/County/Province:  _____________________________________________

* Your Zip or Postal Code:     _____________________________________________

* Your Country:                _____________________________________________

* Your Signature:              _____________________________________________
Application Instructions:

Print this form and the Terms and Conditions of Use. Complete the required information on this form, then mail this form and a signed copy of the Terms and Conditions of Use to:

The WEBworks
1024 Hazelwood Ave.
San Jose, CA 95125-2544

You will receive account information and your password via regular mail within 10 days.

[ WACI Home ]
Copyright 1998, The WEBworks