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Items marked with * are required

Salutation  
First Name * First name is required for proper processing of your credit card information
Last Name * Last name is required for proper processing of your credit card information
Company  
Phone If you want us to be able to contact you by phone, list it here
Email address * This is where your confirmation, configuration files, and instructions will be emailed to
Email address (confirm) * This is where your confirmation, configuration files, and instructions will be emailed to
Desired Username * This is how your account will be identified to DarkWire VPN.
Password * Must be a minimum of 10 characters, max 20 and contain at least one number.
Password (confirm) * Must be a minimum of 10 characters, max 20 and contain at least one number.
Desired Location * New locations are being added regularly, please contact support if you need this changed at a later date
Encrypted Configuration - DO NOT check this unless you know that you require it. Setting this option requires you to enter a password to unlock your configuration each time you use it.  This is absolutely essential for some, or potentially annoying to others.  Please understand what you are doing when you check this checkbox.
Card Type *  
Card Expiration *  
Name on Card *  
Card Number *  
Please Enter the CC Billing Address Below
Address 1 *  
Address 2  
City *  
US State *  
Non-US State/Province  
Country (if not US)  
Zip/Postal Code *  
Select Service Plan  
Group Code If you heard about us from someone in your company or organization, your group likely has a group code.  Ask your IT dept for this code.
Security Question * This can be anything Q/A or challenge/response of your choice.
Security Answer *  
Authorization *   I authorize DarkWire VPN and its parent company to charge my credit card for all monthly charges and any associated fees.

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