Affinity Telecom Orderpage

Telegroup Global Access 800   -   ORDERFORM

Please fill in all relevant fields, print out the application, sign it and then fax it to the regional office nearest you.

GENERAL TERMS AND CONDITIONS *$20 monthly fee per toll free 800 number.
*No charge for unanswered calls!
*Service available worldwide - from US to any country!
*All rates are per minute and in US Dollars!
*No V.A.T. Taxes if billed outside the USA!
*No change in current long distance carrier!
*Credit Card Debit required! THIS IS HOW IT WORKS Calls can be received from the U.S. and Canada to your overseas location. We provide you with an 800 number(s) to call in the U.S. and Canada that you can publish. When your customer or salesperson dials the 800 number in the U.S, our switch routes the call to the overseas location and you are billed for the 800 calls. If the call originated in Canada, it is rated as if it were a GA CallBack call from the customer's country to Canada plus $.15 per minute.

Title:
First Name:
Last Name:
Social Sec.#
(Company):
(Tax ID):        Contact Phone:
E-mail:
Address:
City, Province:
Postal Code:
Country:

YES, I WANT TO ORDER GLOBAL ACCESS 800 SERVICE   Estimated monthly usage (in $US):
Terminating telephone numbers Overseas (must include at least one number).
Enter the phone number(s) that each different 800 number(s) should be forwarded to - include country code*:
1:       2:
3:       4:
*Note: There is a monthly charge of $20 per 800 number, in addition to any usage (call charges incurred).
Credit Card Payment information:
Type of card: Expiration Date:
Cardholders name: Card number:
Authorization & Letter of Agency (LOA)
Customer hereby requests Global Access™ 800 service(s) from Telegroup. If this service order is granted with credit card as the payment method, Customer authorizes Telegroup on a monthly basis, charge the above listed credit card number for all charges attributable to the services ordered. 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 Telegroup and its agents to perform credit checks and to investigate the bank references and other credit or financial information or references submitted to Telegroup, where permitted. The undersigned represents that he/she has authority to request Global Access service(s) for the Customer, and that the Customer understands rates are subject to change without notice. By signing in the authorized signature space, the customer also accepts full responsibility for payment for all misdialed 800 calls. This service may be cancelled at any time by contacting customer service or sending us a written notification.
Name/Title - Please Print:_______________ Authorized Signature:__________________     Date: _____/_____/_____.

Please print this order page, sign and fax it to the regional office nearest you:
+1-509-351-7948(USA) +44-20-75048434 (UK) +46-8-59814570(SWEDEN)