Organization:(Enter up to 70 characters maximum) What Qualifies and Differentiates This Provider:(Enter up to 3 lines, 205 characters maximum) Customer Satisfaction Policy:(Enter up to 3 lines, 205 characters maximum) Contact Person: First Name: Last Name: Street Address:(Enter up to 70 characters maximum) City:(20 max) State/Province:(20 max) Zip Code:(10 max) Country: USA Australia Canada France Germany Mexico Netherlands United Kingdom Home Page (leave blank if none): E-Mail: Phone: Fax: How would you like to receive requests for registration/purchase/information? (note: charges are per transmittal) E-Mail (free) Fax ($2) US Mail ($3) Choose Provider Password (7-10 characters, letters and/or numbers, case sensitive. Please make a record of this password as you will need it each time you add a resource.): Entered By: Phone: E-Mail: