Thank you for you interest in Tactical Digital Conferencing. To sign-up for Meeting Center, please complete the form below. * Are required fields


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COMPANY INFORMATION
Company Name*: Accounts Payable Contact:
Billing Address (line 1)*: Billing Address (line 2):
City*: State*:
Zip Code*: Purchase Order Number*:
Moderator 1 INFORMATION
Moderator/User Name*: Last Name*:
Job Title*: Telephone*:
Fax: Email Address*:
Complete only if different than the billing address:
Mailing Address (line 1): Mailing Address (line 2):
City: State:
Zip Code: Country: USA/Canada
Comments/Specific Instructions:

Would you like to be prompted to enter a bill code for each call? Yes No
ACCOUNT INFORMATION
Are you an existing Tactical Digital customer?
If you are an existing Tactical Digital customer, please enter your account number:
How did you hear about Tactical Digital?
Agent Name:
Agent Rep Number:
ADDITIONAL MODERATOR INFORMATION
Please specify up to four additional Moderators for this account.
MODERATOR 2 INFORMATION
Moderator/User Name*: Last Name*:
Job Title*: Telephone*:
Fax: Email Address*:
Complete only if different than the billing address:
Mailing Address (line 1): Mailing Address (line 2):
City: State:
Zip Code: Country: USA/Canada
Comments/Specific Instructions:

Account Billing code Activation Yes No
MODERATOR 3 INFORMATION
Moderator/User Name*: Last Name*:
Job Title*: Telephone*:
Fax: Email Address*:
Complete only if different than the billing address:
Mailing Address (line 1): Mailing Address (line 2):
City: State:
Zip Code: Country: USA/Canada
Comments/Specific Instructions:

Account Billing code Activation Yes No
MODERATOR 4 INFORMATION
Moderator/User Name*: Last Name*:
Job Title*: Telephone*:
Fax: Email Address*:
Complete only if different than the billing address:
Mailing Address (line 1): Mailing Address (line 2):
City: State:
Zip Code: Country: USA/Canada
Comments/Specific Instructions:

Account Billing code Activation Yes No
MODERATOR 5 INFORMATION
Moderator/User Name*: Last Name*:
Job Title*: Telephone*:
Fax: Email Address*:
Complete only if different than the billing address:
Mailing Address (line 1): Mailing Address (line 2):
City: State:
Zip Code: Country: USA/Canada
Comments/Specific Instructions:

Account Billing code Activation Yes No