Welcome to the Affinity Telecom Online orderpage!
First Name:	Last Name:	Social Sec# (US or Scandinavia only)
(Company):	(European VAT# or US Tax ID#):	E-mail:
Address:	City/Town:	State:
Postal Code (Zip):	Country:	Contact Telephone or fax:
Select the services you want to order:
Pre-select calling (PIC) - Please change my carrier to Primus so I do not need to dial prefix.
Prefix calling - Dial a 5-7 digit prefix before the destination number.
Available in: Netherlands, Norway, Denmark, France, USA, Sweden Switzerland
Global Access Direct - Dial a freephone/toll free or local access number before the destination number.
Available in: Canada, Chile, Brazil, Bahamas, Denmark, Dominican Rep., France, Hungary, Israel, Poland, Portugal, Mexico, Netherlands, Spain, Switzerland, Sweden, UK, USA, Venezuela
Global Access Callback - Call a US access number, hang up and allow us to call back with a US dial tone.
Available in: Any Country in the world, mobiles or land lines.
Primus Passport - Global Calling Card
Available in: 45 Countries
How many travelcards do you need?:

Fixed land lines/fax to be connected:
Mobile Phone Numbers to be connected: (Does not change your mobile service provider)
Method of Payment
Credit card - Monthly call detail + debit below credit card. (Manditory for orders outside Denmark, Norway, Netherlands, Sweden, or the USA)
IMPORTANT NOTE: The card used must be linked to the billing address you have written above and with the same name as the applicant/contact person. Fraud attempts will be reported and IP address involved turned over to local authorities.
Type of Credit Card:	Credit Card Number:	Exp Date (mm/yr):
Visa MasterCard EuroCard
Invoice - I wish to be invoiced (You may then pay the invoice by check/wire/giro*) A Credit history check may be performed. This payment option is only available in: Denmark, Norway, Netherlands, Sweden, and USA.
Authorization & Letter of Agency (LOA)
Customer hereby requests international long distance service(s) from Primus Telegroup. If this service order is granted and either credit card or Check/wire/giro is the payment method, Customer authorizes Primus Telegroup to either charge the above listed credit card number for all charges attributable to the services ordered or send an invoice for payment within 30 days. If credit card billing is selected, the undersigned understands that the same terms and conditions normally governing the use of the credit card apply to this use as well. Customer authorizes Primus Telegroup to perform credit checks and to investigate the bank references and other credit or financial information or references submitted to Primus Telegroup, where permitted. The undersigned represents that he/she has authority to request international telephone service(s) for the Customer, and that the Customer understands rates are subject to change.
Please allow 1-3 business days for order process.
If you do not want to send your information via internet please print this page, sign and fax to the office nearest you: Name:_________________________ Signature:_________________________  Date:____/____/____ Affinity Telecom North America, 1134 Villa Calimesa Ln, Suite 8, Calimesa CA. 92320, U.S.A FAX:+1-877-689-2259 Affinity Telecom Europe, Sundby Park - Box 674, 645 59 Strängnäs -SWEDEN FAX:+46-152-10043