New User - QuickModules.Online

User Information
Fill in your information to create a user account
Company Information
Informarion about the company you are working for.

Username

Email Address

Phone Number

Password

Confirm Password

First Name

Middle Name

Last Name

Question #1

These questions and answers are in case you forgot your password. Please remember them.

Answer #1

Question #2

Answer #2

Question #3

Answer #3

By checking this box, I authorize Fairfax Software to store and process any Personally Identifiable Information that I provide to Fairfax Software for the purposes of, and only the purposes of its use in the 1042S Data Integrity Solution. Fairfax Software will restrict processing and storage of any personally identifiable information not explicit authorized by this authorization. Fairfax Software utilizes the individual authorized storage and processing of personally identifiable information solely for the purpose of completing the 1042S processing completely contained within this application. Customer acknowledges that customer has the right to revoke or terminate this authorization by deleting or terminating its online account in the 1042S Data Integrity Solution, at which time, Fairfax will immediately delete and sanitize all previously authorized personally identifiable information.

Company Name

Tax Identifier Number of Employer

Position

Address Line 1

Address Line 2

City or Town

State or Province

Zip or Foreign Postal Code

Country