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 Service
1-Year ($32.00/mo)
6-Mos. ($32.50/mo)
$
- Activation: $15.00 - First 150 calls/month FREE, 25¢/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"):
OPTIONAL NUMERIC SERVICES
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.)