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                      |  `!.-Asia Application-.!'  |
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   Handle: 

   Real Name:

   Birth Date:   /  /  

   Voice #:

   Data/Fax #:

   Application Type(distro.artist.courier):

   Years Experience:

   Current Affils:

   Past Affils:

   City/State:

   Zip Code:

   Address:

   Are You Willing to call ld(y/n):
       
       
       
       If you are applying for a distro site, this is mandatory
            otherwise, if its applicable. Fill it out:)

   
   BBS Name:

   BBS Fone #:

   Total # of Users:

   Affils:

   Meggage:

   AC/State:

   Board Support(hpavc/art/warez):

   Total # Of Calls Per Day:


       
       Thank you for filling out our application. Please Upload
         this to our whq. Eternitys Salvation (216)834-0085!
    If your applying as an artist, please also include 3-5 Samples
        of your "best quality" artwork. (we are ascii only..)