User ID Request Form

Q4B Document Center

Complete this form to become an Authorized User of Q4B Document Center.
Applicants must qualify with respect to our occupation guidelines, which
include the legal, accounting, investment, insurance and similar professions.
Special requirements apply to Arizona users; see Getting Started for details.
A Fee Schedule will be provided to you upon the activation of your User ID.
(There is no charge to activate your User ID. Fees are based on usage only.)

First Name:

Middle Initial:

Last Name:

Your Occupation:

Company Name (required if billing to company):

Title or Position (in company):

Street Address:

City:

State: Zipcode:

Phone: Fax:

E-mail:

Enter a User ID (6 to 8 characters, if blank we will provide one):

Special Requests or Comments:

By submitting this form you acknowledge that you have read the Terms Of Use and that
you agree to be bound by them. If you have filled-in a Company Name above, you also agree that
the company will be bound by the Terms Of Use and that you have the authority to bind the company
to such an agreement. You further represent that the information submitted is true and accurate.

First Name:
Middle Initial:
Last Name:
Your Occupation:
Company Name (required if billing to company):
Title or Position (in company):
Street Address:
City:
State:	Zipcode:
Phone:	Fax:
E-mail:
Enter a User ID (6 to 8 characters, if blank we will provide one):
Special Requests or Comments: