New Member Application

(required fields are in bold type.)

Company Contact Information
Company Name:
Company Address:
City:
U.S. State: (or Canadian Province)
State or province Required for US or Canada
ZIP/Postal Code: Required for US or Canada
Country:
Telephone:
Fax:
Sales Representative:
(please enter the name of your Sales Rep, if known)


Additional Company Information
Website:
Business/Industry:
Structure:
Public/Private:
Stock Symbol:   Exchange:   (if public)
Which wire service do you currently
use/have you used in the past?
Will you send releases as an
agency for another organization?
How did you hear about GlobeNewswire?


Billing Contact
First Name:
Middle Name:
Last Name:
Position/Title:
Address:
* Physical addresses only - no P.O. boxes please
City:
U.S. State: (or Canadian Province)
State or province Required for US or Canada
ZIP / Postal Code: Required for US or Canada
Country:
Telephone:
Fax:
Email:
* Corporate email addresses only
If physical or corporate
email address not
provided, please explain:

Please note, your email address will be used to log into your GlobeNewswire account.



Primary Contact
The Primary Contact is the person responsible for business and operational issues,
such as approving news releases, updating fax or email lists, and modifying content
on any web pages we maintain for you.
Primary Contact is same as the Billing Contact
First Name:
Middle Name:
Last Name:
Address:
* Physical addresses only - no P.O. boxes please
City:
U.S. State: (or Canadian Province)
State or province Required for US or Canada
ZIP / Postal Code: Required for US or Canada
Country:
Telephone:
Fax:
Email:
* Corporate email addresses only
If physical or corporate
email address not
provided, please explain:




Comments / Instructions:

(Please enter any special comments or instructions above)



Terms and Conditions:

(By submitting this form, you agree to the terms and conditions specified above.)

Enter the code below:
Security Image

After you click the Submit Form button, you will see a confirmation page.
Please verify your information, and if your information is complete and correct, then click Confirm .