More Than Just Long Distance Savings.....
CUSTOMER INFORMATION |
Company Name:_________________________________Fed.ID#:_______________________
Contact Name:___________________________________S.S.#:_________________________
Street Address: (no p.o. boxes)____________________________________________________
City:___________________________________________St:___________Zip:______________
Mailing Address:_______________________________________________________________
City:__________________________________________St:____________Zip:______________
PLEASE ENROLL THE FOLLOWING SERVICES TO TELECARE |
U.S. MAINLAND INTERSTATE RATE: 8¢ PER MINUTE + 30 SECOND MINIMUM / 6 SECOND INCREMENTS
ONE PLUS: Main Telephone Number: (______) ______-________
Additional #'s (______) ______-________ (______) ______-________
Additional #'s (______) ______-________ (______) ______-________
Additional #'s (______) ______-________ (______) ______-________
TRAVEL SERVICE: { } Please Send _____ Travel Cards (15¢ per. min. No Surcharge)
800/888 SERVICE: { } Please assign a Toll Free Number to ring to: (______) ______-________
Toll Free Service is 9¢ per minute interstate/anytime in the continental U.S.
{ } Please assign my existing Toll Free Number to your service (NEED to contact me)
CELLULAR L.D. : { } Please assign my cellular long distance #: (______) ______-________
cellular long distance is 15.5¢ 7 AM to 7PM and 12¢ 7PM to 7AM in Cont. U.S.
CUSTOMER AUTHORIZATION |
I authorize Telecare, Inc. to provide my long distance service as my underlying long distance provider,
and to act as my agent in all matters related to providing my long distance service for the telephone
number(s) listed on this form. I understand that: (1) I may only subscribe to one long distance carrier
for the listed telephone number(s). (2) There may be a one time fee from the local telephone company
for subscribing my long distance service to Telecare. Subscriber, by signing this application,
guarantees Telecare that all statements will be paid on or before the past due date or subscriber will
be responsible for costs associated with collections.
AUTHORIZED SIGNATURE:_________________________________________ Date:______________
(Optional) I authorize Telecare, Inc. to pay my monthly statement by the bank card listed below. I will
receive a monthly call detail report. Credit Card Type: Visa / MasterCard (circle one)
Card#_______________________________________________________ Exp.__________________
Customer Signature:______________________________________________ Date:____________
Agent Number 031/D2D BKR# 006/020
YES! Please send me info on:
{ } Telecare/Pagenet Paging { } Telecare Unlimited Internet Service (17.95 monthly)
For Services Listed Above, Please Print Out This Page, Complete It & Send It To Me...
Or, If You Have Any Questions, write to me:
EARL BRIDGES, 4657 Evans Ave., Saint Louis, MO 63113
(12/03)
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