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

Pager Rental Agreement
Please complete both this Order Form and the Rental Agreement.


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:
Your Rental Pager

Pronto FLX

Bravo FLX

Ultra Express FLX

 $

 $

 $



Local Coverage Area Choose an Area Code for your Pager's desired Local Coverage: Please describe your desired Local Coverage by providing us with 2 or 3 major cities you want coverage for:
Service Options

Local Numeric Pager Rental

1-Year ($8.99/mo)

6-Mos. ($9.50/mo)

 $

 $

- FREE Activation!
- First 1,000 calls/month FREE, 12¢/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"): 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:
Totals
Pager Rental/Service Total $ Processing Charge $ Subtotal $ 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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