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Please complete this AvrefWeb registration form and click on the 'Submit' button at the bottom of the page when you are done. If desired, passwords and challenge question/answer can be the same for multiple users. However, each user should have his/her own unique email address! An email confirmation will be sent to each authorized user once your online accounts have been established. All fields must be completed for each authorized user.
Please note: Fields marked with an asterisk * MUST be completed!
Company Name
*
City, State (or country)
*
Phone Number
*
Contact 1 Name
*
Contact 1 Email Address (Should be unique for each authorized user)
*
Contact 1 Requested Password (minimum 7 characters with at least 1 numeral)
*
Contact 1 Challenge Question
*
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Contact 1 Challenge Question Answer
*
Contact 2 Name
Contact 2 Email Address (Should be unique for each authorized user)
Contact 2 Requested Password (minimum 7 characters with at least 1 numeral)
Contact 2 Challenge Question
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Contact 2 Challenge Question Answer
Contact 3 Name (may require additional fee)
Contact 3 Email Address (Should be unique for each authorized user)
Contact 3 Requested Password (minimum 7 characters with at least 1 numeral)
Contact 3 Challenge Question
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Contact 3 Challenge Question Answer
Contact 4 Name (may require additional fee)
Contact 4 Email Address (Should be unique for each authorized user)
Contact 4 Requested Password (minimum 7 characters with at least 1 numeral)
Contact 4 Challenge Question
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Contact 4 Challenge Question Answer
Contact 5 Name (may require additional fee)
Contact 5 Email Address (Should be unique for each authorized user)
Contact 5 Requested Password (minimum 7 characters with at least 1 numeral)
Contact 5 Challenge Question
🛈
Contact 5 Challenge Question Answer
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