Mail-in Account Transfer Request Form

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Use This Form To Transfer Your ActiveSET.org Services If Your Company Name Has Changed
Mail The Completed Form With Your Business Card To:	ActiveSET.org / Attn: Priority 3335 NW 47th Terrace  Gainesville, Fl 32606 USA

Important - Write Clearly Or Type In

Type Of Business:	Stack Testing Firm / Consultant		Regulatory / Government
	Related Services & Products		Industry / Plant Manager
	Other: __________________________________________

Old Company Name: ______________________________________________________________________________________


NEW Company Name: _____________________________________________________________________________________

Do You Want ActiveSET.org To Re-Scan Your Logo? (This is a free service)    No Thank You

Yes. Re-Scan Our Logo At This Web Address: ______________________________________________________________________

Yes. Use the enclosed artwork on disk or letterhead.


By submitting this request the NEW Company agrees to the terms & conditions of the ActiveSET.org Advertising Services Agreement
Visit: www.activeset.org/terms.htm

I / We Agree to the terms & conditions of the ActiveSET.org Advertising Services Agreement

Name: ___________________________________________________________________________________________________


Signature: _______________________________________________________________________________________________


Daytime Phone: ___________________________________________________________________________________________
 Area Code + Phone Number (111-222-3333)

Street or P.O. Box: ________________________________________________________________________________________


City: _______________________________________________________ State/Prov: __________________ Zip: ____________


e-Mail Address: ___________________________________________________________________________________________

ActiveSET.org will change your Online Listing & Billing Information to the NEW company name you entered above.
If you need to make additional changes to your account information please check the
appropriate box below. Attach a separate sheet for your changes if needed.

Do you need updates to your OnlineListings?		Yes. I have attached these updates to a separate sheet.
		No. There are no changes to our Online Listings other than our NEW company name.
Do you need updates to your Billing Information?		Yes. I have attached these updates to a separate sheet.
		No. There are no changes to our Billing Information other than our NEW company name.

An Account Transfer Fee Is Required Only For Company Buyouts Or Mergers Was Your Company Acquired, Bought By Or Merged With The NEW Company? Yes. I Have Enclosed Payment For The $225 Account Transfer Fee No. Our Company's Ownership Has Not Changed

I authorize Emissions Schematics to bill my credit card $225 for the Account Transfer Fee.
(ActiveSET.org is owned & operated by Emissions Schematics. Your credit card will be billed as "Emissions Schematics")

Cardholder's Full Name as it appears on the front of the card:


____________________________________________________________________________________________


Credit Card Number:


____________________________________________________________________________________________



Expiration Date - Month: _____________ .. Year: __________

Mail The Completed Form With Payment & Your Business Card To:
ActiveSET.org / Attn: Priority
3335 NW 47th Terrace  Gainesville, Fl 32606 USA