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      Business/Organization Subscription Application

Category One Year Two Years
         Non-Profit Organization $50.00 $90.00
         Small Business     (15 or fewer employees) $50.00 $90.00
         Large Business   (more than 15 employees) $75.00 $135.00

Your First Name: 
Your Last Name: 

Company Name: 
Street Address: 
City:  State:  Zip: 
1st Phone Number:     TTY Voice Both
2nd Phone Number:   TTY Voice Both
Fax #: 
Pager #: 
Your E-mail Address: 

Your Instant-Messaging (IM):  (if any)
      Service:
   User ID:
Your Company's Website URL:
  

Your choice for listing in the directory?         
Your choice for your business category in the directory?
   
Note: For more than 1 category, contact TDI.

Do you want to be listed in the electronic directory? 
Do you want your address shared with any kind of service?    
Membership Fee: 
Do you want to purchase 2003 "Blue Book" directory for only $15.00?
           (valid only with purchase of this membership)           
Contribution (Thank You!): 
 
Payment:              
If paying by credit card, enter the following:             C.C. Expiration Date:
Credit Card Number:            (mm/yy)
Your name as shown on credit card:  
 
If by purchase order, enter its PO number:
& fax or mail a copy of this PO to TDI in addition to this form printout.

Are you a new subscriber or are you renewing your subscription at TDI?
                                             

                   NOTE:  Fill in the fields before printing this Form out.
            Sign your name below before faxing or mailing the printed Form to:

                         TDI
             8630 Fenton Street, Suite 604
            Silver Spring, Maryland 20910
                               U.S.A.
                     301-589-3797 FAX

       Cardholder's Signature: ____________________________________

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                           Copyright © 2001 TDI    All Rights Reserved   Last modified: December 24, 2003