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Regional 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:







Local Pager Number Choose an Area Code for your Pager's Local Modem number:
Service Options

Regional AlphaNumeric Pager Rental

1-Year ($34.00/mo)

6-Mos. ($36.00/mo)

 $

 $

Please choose One Region:

 Western Central Northeast Southeast Southern

Second Region - Add $4.00/month. Please choose your Second Region:

 Western Central Northeast Southeast Southern

- Activation: $15.00
- First 100 calls/month FREE, 27¢/call thereafter
(charged to your credit card on file)





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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