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Use this form to request additional information from our sales department or sign up to test drive clearTXT at your school (school representatives only please).

How may we help you?

  I'm interested. Contact me with additional information.
       Select this option to have a sales representative contact you with additional product information to help
       connect your campus.

  I'm ready. Set up my account.
       Select this option to connect your campus now. You will need technical information regarding your
       E-Learning system and server information to complete this form.

Name:
Title at school:
Work Phone number:
Mobile phone number:
Email address:
Mailing address:
Will you be the person managing clearTXT at your school?	Yes No
How did you hear about clearTXT? (Check all that apply)	Conference or Event Referral Internet Search Call from clearTXT Email from clearTXT Direct Mail from clearTXT Online Directory Online Article Print Article Web link on a website Other

School Name:
How soon do you need clearTXT?
What E-Learning System does your school use?

Technical Information:

Do you plan to integrate clearTXT with Blackboard? (i.e., get the clearTXT Building Block)	Yes, and I will install the building block myself. Yes, and I would like you to install the building block for me. No
Live/Production Server where you plan to install the extension (full URL)
Test/Development Server where you plan to install the extension (full URL)

Instructor Account
Username:
Password:
Student Account
Username:
Password:
Admin Account
Username:
Password:

Additional comments or requests:

ClearTXT

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