Complete this form and return it immediately for an application to be sent out to you by directmail, email, and/or by fax.  Your new Virtual Office will be setup for you within 48 hours from our receiving your request form and your completed application.

FAX TO:
1-866-RTISTIC!
(1-866-784-7842)

DATE:  ___________________

FROM: 
Your Name:  _______________________________________________

Company:  (If any) ___________________________________________

Fax Number:  (with area code) __________________________________

Telephone Number: (with area code) _____________________________

Email Address:  _____________________________________________

Website URL: (If any) _________________________________________

How did you hear about us?  ___________________________________

_________________________________________________________

If referred by one of our agents, representatives, brokers, or consultants; provide their name
below for proper credit to their account.

Referred By:  ______________________________________________

DIRECTMAIL REQUEST:  If you prefer that we forward our Virtual Office Introduction
Packet out to you by directmail, please provide your mailing address and return this form by
email, fax or directmail as provided below:

Directmail to me at:  Name:  ____________________________________

                                     Business Name:  _____________________________

                                     Address:  __________________________________

                                     City, State, Zip:  _____________________________


Or return this form for processing to:
Artistic! Capital Corporation
Corporate Offices
342 E. Jericho Tpke., Ste. 334
Mineola, NY  11501-2111
Attn: Virtual Office - New Accounts