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National 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:
Service Options

National AlphaNumeric Pager Rental
1-Year ($40.99/mo)
6-Mos. ($43.50/mo)
 $
 $
- Activation: $15.00
- First 100 calls/month FREE, 27¢/call thereafter
(charged to your credit card on file)


                                             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"): 





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.



   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.)




Additional Per Month

Numeric VoiceMail Service:

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"):


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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