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
National Numeric Pager Service
1-Year ($19.95/mo)
6-Mos. ($21.50/mo)
$
- Activation: $15.00 - First 400 calls/month FREE, 15¢/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 $