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Regional 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 Pager Number Choose an Area Code for your Pager's Local phone number: (If you are ordering an 888 or 800 number, please enter "888" or "800" and then select the option in the Optional Services below. The cost is $6.50/month and $5.25/month respectively.)
Service Options

Regional Numeric Pager Service
1-Year ($15.95/mo)
6-Mos. ($16.50/mo)
 $
 $
Please choose One Region:

 Western Central Northeast Southeast Southern
Second Region - Add $3.00/month. Please choose your Second Region:

 Western Central Northeast Southeast Southern
- Activation: $15.00
- First 400 calls/month FREE, 10¢/call thereafter
(charged to your credit card on file)




OPTIONAL SERVICES
Additional Per Month 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 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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