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Required Field
Important: Passwords must be 8 characters or more, and must include: 1 Uppercase; 1 Lowercase; 1 Number; 1 Special Character from these bolded five: !: @: #: %: &.

Make sure there are 8 or more characters in total!

Required Field
UserName: Must be an email address that ends with either one of these: .com: .org: .net: .int: .edu: .gov: .mil.

Required Field
First Name: Only English Alphabet letters accepted w/ no spaces in between them.

Optional Field
Middle Initial: Only One English Alphabet letter accepted.

Required Field
Last Name: Only English Alphabet letters accepted w/ One optional apostrophe.

Required Field
Company Name: Only English Alphabet letters; Numbers; and these Chars accepted: !: @: $: #: %: &: _: |: .: ?: and 1 '.
Example: Dolby Laboratories, Inc. [Short Version]

Example2: BestOfTheBest LLC. | Dept. @Network. [Longer Version]

Required Field
Company Street Address 1: [Format Sample: (Number(s)_1Space_Letters_Or_Numbers_1Period)
Example: 1234 OneStreet Rd. [Optional: Other entries could be: Street; St.; Blvd.; Court.; Circle.; etc...

Optional Field
Company Street Address 2: Other informatin can be entered here such as Bldg# 12345; and Chars such as .: and -hyphen w/ up to 2 spaces.

Required Field
City Only English Alphabet Letters w/ up to 2 spaces. Example: Los Angeles.

Required Field
State You Must select one of the states in States from the select box.

Required Field
Zip Code Zip can either be input as a 5 Number Digit entry or as a complete Zip Code as shown below:
12345 [Short Version] or
12345-0000 [Long Version]

Required Field
Country Country is READ ONLY:

Optional Field
Company Web Site This should start with either http://www.webaddress.any
or
http://webaddress.any
or
www.webaddress.any

Required Field
Phone Please select one or more choices from the left. Based on your selection input boxes should show automatically to the right.

If directions have been followed completely while making your entries and yellow warnings still show you may call us immediately for help.
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To Register: Please enter information on both forms and then click the Green REGISTER button below. If you need to start anew just click CLEAR FORM button at its left side. To go back to the main page click the HOME button at the bottom, or you can click COUPONS button to see current subscribed Merchants and their offerings. Click EXIT Button to Close Window/Exit Application.

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