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Your Company Details
Full Company Name Company Type  
 
(The official registered name of your business)
Common Company Name Company/CC Reg No. Reg Type
(This is the name you will use for your ISP)
VAT Number    

(this will displayed on your end-user invoices)
 
Physical Address Postal Address  
 
 
 
 
 
Your Contact Details
Title First Name Last Name
Primary Function ID Number Type of ID Number
Telephone Telephone  
Work Cell  
After-hours Fax  
   
Email (Use to complete registration)
Company Banking Details    
Bank Name Branch Branch Code
(Click any of the fields above to load the Bank Selector popup.)
Account Name Account Number Account Type
Login Preferences
Preferred UserName    
   
Choose a single word (3 characters or more),preferably one that indicates your company name.
This username will become the first part of your email address.
Preferred Password    
   
Choose the password (5 characters or more) that you would like to use to access all private areas.
Dailup Location    
   
Select your dialing area. If you are not in any of the above dialing codes, select 'Other'.
How Did You Hear About Data Pathway?
How did you hear about us? Name  
 
     
Sales person Code
Sales person Code    
   
If you were referred by a sale person please enter their sales code here
If you were not then please leave thisblank.