AUCTIONWARE, LLC TRIANGLE SALES

AUCTIONWARE, LLC TRIANGLE SALES
RADIOGRAPH REPOSITORY VETERINARIAN REGISTRATION FORM

For all Veternarians Requesting a User ID & Password
Asteris Keystone Community Radiograph Repository
First & Last Name *

First Name Last Name
License Number *
State *
Organization
Email *
example@example.com
Organization Website
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number (mobile) *
Please enter a valid phone number.
Phone Number (office) *
Please enter a valid phone number.
I have read, understand and agree to the Radiograph Repository Terms.

I understand that User Name and Password are non-transferrable and will expire at the conclusion of each sale.

I understand that all radiographs contained in the Radiograph Repository are confidential and that printed or electronic distribution is prohibited.

Any violation of the Terms and Rules of Use will result in the revocation of viewing privileges.
Signature *

Clear
Date *

Month Day Year
Date
Rexann Morrison • Triangle Sales Repository Agent • (817) 694-1711 thexraylady@gmail.com
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