Contact Name: 
Company:      
Address:      
Address:      
City:           State/Province: 
Country:        Zip/Postal Code:
Daytime Phone:  Evening Phone: 
Email notification address (required):   

Notification is by email, would you like to be paged?

No
Yes
Pager Number:

Billing Period:

6 months 1 year

Liability Release and Service Contract

By submitting this application I, , request initiation of the Aesir On Guard service at current rates. I understand that I may cancel my account with 30 days notification to Aesir and will receive a prorated refund for any unapplied balance.

I will be billed at the start of each billing cycle as specified above.

I hereby agree to hold harmless Aesir Computing, Inc., its employees, partners and agents for any and all damages or losses caused, directly or consequentially, by the provision, failure or interruption of Aesir On Guard Services.

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