Brand Holder Enrollment Form

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brand_hello

 

Brand&magnifier  

 

brand_name

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You are requesting to have access to the IPRCENTER proprietary data base. This database contains proprietary information and intellectual property. Your access will be limited to your company’s pages and IPRCENTER generic pages.

PICA Corporation, will read your application information and contact your company to verify that your request is legitimate.

When your application will be accepted we will send you two separate emails, one with your login and password and one with the URL for login.

Please fill the form below and send it when done. Note that some fields are mandatory.

Your First Name (required)

Your Last Name (required)

Your Title/Function

Date

Your Company Name (required)

Company or Office Street Address

Company or Office City

Company or Office State

Company or Office Zip Code

Company or Office Country

Your Main Phone Number (required)

Alternate/Cell Number

Your Email (required)

Generic Company Email Address - Please verify (required)

Choose a Password (required)
(minimum 8 characters, must have at least 1 number and at least 1 letter)

Contact Department/Personnel (for verification) (required)

Organization Affiliations

Other Organizations

Please provide any additional information

Thank you for your interest with the IPRCENTER.
The IPRCENTER Team.

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