New account

Customer name

Delivery address

Billing address

Home phone number
Business phone number
Type of payment
Invoice required
Email receipt acceptable
Email reminder needed
Purchase Order expected

Credit card details

Card number Expiry Full name

Email address:
@ .vt.com <>
Initial password (not same as any other used elsewhere)

Machine/OS Type


Windows details


Install floppy
Hard drive
Com port
Baud rate (use 19200 if you have a 14400 modem, 38400 if you have a 28800 modem)

Macintosh details

Baud rate (use 19200 if you have a 14400 modem, 38400 if you have a 28800 modem)
Starter Kit required

Dialling info

Calling which PoP?:
Service
IP Address Link address
Alert date Expire date

mail out or collect (say when)
Comments:

Order submitted by Enter the account creation password here: