• Your Name *
  • Your Email *
  • Company Information
  • Company Legal Name *
  • Phone *
  • Street Address *
  • City *
  • State *
  • Zip Code *

    • Primary Contact
      The primary person who will be working with Fuse and is considered an Authorized Approver

    • Contact Name
    • Title
    • Phone
    • Street Address
    • City
    • State
    • ZIP Code

    • Billing Contact
      Where should we send the invoices and discuss billing-related matters?

    • Contact Name *
    • Title *
    • Phone *
    • CC: E-Mail Others?
    • Street Address
    • City
    • State
    • ZIP Code
    • Billing Information and Terms
      All services rendered during the month are invoiced on the last day of the month and are due within 15 days. Any fees that remain unpaid for more than 15 days after the date on the invoice will be subject to interest on the unpaid amount(s) until and including the date payment is received, at the lower of either 1.5% per month or the maximum allowable rate of interest permitted by applicable law. Fuse reserves the right, but not the obligation, to suspend part or all the Services without prior notice in the event that any portion of fees are not timely received by Fuse

    • Authorized Approvers
      These are the employees who are authorized to approve new services or agreements between you and Fuse
      Please Secify at least one additional approver.

    • Primary Authorized Approver
    • Contact Name
    • Title
    • Phone Number

    • Additional Authorized Approver
    • Contact Name
    • Title
    • Phone Number

    • Additional Authroized Approver
    • Name
    • Title
    • Phone Number

    • Authorized Vendors
      The vendors listed below are authorized to work with Fuse Networks and its staff on your behalf, unless otherwise noted by Customer.


    • Internet Service Provider
    • Service Provider Name
    • Internal Contact
      ?
      This is the person that is authorized on your account and allowed to make changes.
    • Invoice Copy

    • Phone Vendor
    • Vendor Name
    • Internal Contact
    • Invoice Copy
    • Acknowledgement and Approval *