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       APPLICATION FORM
  
    


   PERSONAL INFORMATION
   
           SysOp Name  
    Home Phone Number 
        Date of Birth 
        
        BBS INFORMATION
        
             BBS Name 
         City & State 
         Phone Number 
         BBS Software 
      Number of Nodes 
     NetMail Software 

        HUB INFORMATION
        
   Preferred Mail Hub 

OUR ACCOUNT INFORMATION

           Login Name 
       Login Password 

