AS4 Services Enrollment Form

     * The following information is required

*Company Name:
*Company URL:
*Product Name:
*Product URL:

This AS4 Registration is for:

AS4 ITQ
AS4 Interop

Products tested are required to be available on the market at most 90 days after the test concludes.

*Product Commercial Status: (check one)

Available Now
30 days after test concludes
60 days after test concludes
90 days after test concludes

The following information assists us in preparing for the test.

*S/Mime Toolkit: (select all that apply):

Entrust RSA Java IAIK Other
Specify Other:

Administrative Contact

This person is the primary point of contact and is responsible for the overall relationship and commitment of resources.

*First Name:
*Last Name:
*Title:
*Address:
*Phone:
*Fax:
*eMail:

Accounts Payable Contact

If specified invoices will be directed here, otherwise they will be sent to the administrative contact.

Check here if the Accounts Payable contact is the same as the Administrative Contact

Name and Title:
Address:
Phone:
Fax:
eMail:

Technical Contact

This person is required to operate and support your product during the execution of the interoperability test.

Check here if the Technical contact is the same as the Administrative Contact

Technical Contact 1
Name and Title:
Phone:
eMail:
Technical Contact 2
Name and Title:
Phone:
eMail:
Technical Contact 3
Name and Title:
Phone:
eMail:
Technical Contact 4 d
Name and Title:
Phone:
eMail:

Press Contact

If specified all press releases and other advertising or marketing collateral will be cleared with this person prior to their release, otherwise the administrative contact will be used.

Check here if the Press contact is the same as the Administrative Contact

Name and Title:
Address:
Phone:
Fax:
eMail: