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Local Service E-Mail Order Form
For Electronic Transmission Only - Hit "Send Order" Button to Submit

Personal Information

     Please enter your Name and Address as they appear on your Credit Card Statement:
       First   MI  Last
     Company 
     Address 
        City  State Zip
     Country 

How may we contact you if necessary? (Day Phone Required for Carrier) Day Hours: How did you find us? Night Hours: ("Yahoo", "Excite",etc.) E-Mail
Credit Card Information To split charges across two cards: Card #1 Card #2 Expiration Date: Exp: Amt:
Local Coverage Area Choose an Area Code for your Pager's Modem number: Please describe your desired Local Coverage by providing us with 2 or 3 major cities you want coverage for:
Service Options

Local AlphaNumeric Pager Service
1-Year ($10.99/mo)
6-Mos. ($11.99/mo)
 $
 $
- Activation: $15.00
- First 300 calls/month FREE, 15¢/call thereafter
(charged to your credit card on file)




OPTIONAL SERVICES

                                             Additional Per Month

   AlphaNumeric VoiceMail:
    Personal 888                                 $ 

    - VoiceMail Access Code (allows you to access your messages)
      Choose a 4-number Access Code (don't start with "0"): 


   Extended Coverage:
    One-Zone Extended Coverage               $ 
    Multi-Zone Extended Coverage             $ 

    - Extended Coverage Code:
        Please enter the Extended Coverage Code found
        in the Local Coverage listings:




OPTIONAL NUMERIC SERVICES

A second number with Numeric service is included with your AlphaNumeric pager. Term length and coverage area(s) are the same as your AlphaNumeric service.






                                             Additional Per Month

   Numeric VoiceMail Service:
    MiniMail                                 $ 
    PageMail                                 $ 
    PageMail Plus                            $ 

    - VoiceMail Access Code (allows you to access your messages)
      Choose a 4-number Access Code (don't start with "0"): 

   Other Numeric Services:
    Personal 888 Number                      $ 
    Common 800 Number w/PIN                  $ 
    Custom Greeting (no VoiceMail)           $ 
    Numeric Retrieval                        $ 

    - Custom Greeting and/or Numeric Retrieval Access Code
      Choose a 4-number Access Code (don't start with "0"): 






Pager Purchase & Totals
If purchasing a pager, please complete the section below:
Qty Order# Description Each Total 1 2 3 Merchandise Total $ Processing Charge $ Subtotal $ Sales Tax (8.25% CA Only) $ Pager Service Total $ 2nd Day Delivery $ Overnight Delivery $ Total Charges $


Thank You for Your Order!


Comments/Ship-To Address (if different than above - delays may result):


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