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My Details
*Date Of Birth
* First Name * Last Name
* E-Mail Address: * Telephone:

* Address 1 (or) PO Box No: Address 2:
* City: * Zip Code:
* Country: * Region / State:
School or Affiliation (Optional) Affiliation Address (Optional)
Affiliation City (Optional) : Affiliation Zip Code (Optional) :
Affiliation Country (Optional): Affiliation Region / State (Optional):
Affiliatiation Phone (Optional) Affiliation Email (Optional)

* Password: * Password Confirm:

(six characters, mix of numbers and letters)

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Reason for applying (Optional) :
* Enter the verification code in the box:  
 I have read and agree to the Terms and Conditions
Note: In order to receive payment for Ambassador Commissions from Case•it, please download and fill out this W-9 form and mail it to the following address:


Company Address:
Att: Ambassador Commissions
Re: Case•It Ambassador Program
1050 Valley Brook Ave
Lyndhurst, NJ

Case•it Ambassadors are responsible for all taxes for their services. See terms and conditions
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Note: Your personal information (ie: telephone number, age, address) will not be visible to the public nor shared or sold to third parties.


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