| phone: 954-726-9501 | fax: 775-665-5799 | email: lotatalk@bellsouth.net |
| AFFILIATE ID | AFFILIATE NAME | PHONE | FAX | |
| LAST NAME | FIRST NAME | COMPANY | DATE | |
| ADDRESS | CITY | STATE | ZIP | |
| PHONE | FAX |
| Pro. Code SERVICE Description | Cost | QTY | Total |
| 1000D* 1000 min (2.9¢ pm) 30 days | $29.95 per line | ||
| 2000D 2000 min (2.1¢ pm) 30 days | $49.95 per line | ||
| 3000D 3000 min (1.9¢ pm) 30 days | $59.95 per line | ||
| 4000D 4000 min (1.7¢ pm) 30 days | $69.95 per line | ||
| *Not Portable | |||
| ACTIVATION One Time Charge | $15 per line | ||
| GRAND TOTAL |
| Pro. Code | Phone Number | Pro. Code | Phone Number | ||||
| _______: | _______- | _________- | _________ | | ________: | _________- | ________- | __________ |
| _______: | _______- | _________- | _________ | | ________: | _________- | ________- | __________ |
|
SERVICE AGREEMENT and CUSTOMER APPROVAL
| |
|
This service agreement is for flat rate phone service available in the contiguous 48 US states with ability to call in the 48 US States
and Canada with prepaid monthly fee (NO per minute charges) for normal business or residential phone use, *special pricing
available for heavy volume users. Lines include: toll free access, three way calling or pin for portability. Lines subject to the
following restrictions: service is for normal voice. No Internet access, faxing, 900# or other billable calling. No pay phones unless
fees are paid by the customer. No sharing or resale. Violation of any of the above terms is considered fraudulent use and all
services will be immediately terminated without notice or refund. Eliminate toll calls and Long Distance calls 24 hours, 7 days,
taxes included. The service is valid for 30 days. NO ANNUAL CONTRACT OR ADDITIONAL FEES are required for service.
I, the undersigned, hereby agree to accept from LOT A TALK, LLC the above chosen flat rate calling service (s). I hereby authorize LOT A TALK, LLC to debit my credit or debit card for the set up fee and the first month's service fee. My account will be debited 7 days prior to the 30th day renewal date of my service. I understand the Service Agreement provided by LOT A TALK, LLC or it's designated service providers, under the general terms and conditions of the service set forth herein. I understand that LOT A TALK, LLC is not responsible for providing the actual long distance service and further agree to hold them harmless for not only any problems or causes associated with the network but also any liable situations that result from not being able to access the network. I further verify that all information provided herein is accurate and correct. I understand that LOT A TALK, LLC reserves the right to change or cancel these services and/or pricing at its' option. Further, I understand that I may cancel this service upon giving written notice to LOT A TALK, LLC at the address shown above. Such cancellation will terminate my services on or before the 30th day renewal date that occurs after the notice is received at the address above. My service will be terminated on the day after the 30th day renewal date if I fail to pay as agreed. I understand that there will be no credits or refunds. | |
| ______________________ | ___________________ |
| CUSTOMER SIGNATURE | DATE |
|
PAYMENT INFORMATION
| ||
| CREDIT/DEBIT CARD NUMBER__________________________ | EXPIRATION DATE________ | |
| Print FULL name as it appears on the Card: _________________________________________ | ||
| Provide Billing address for the Card:_______________________________________________ | ||
| Phone______________________ | Fax___________________________ | Email_____________ |
| IMPORTANT: Credit card will be processed by; SGS Marketing, LOT A TALK, LLC or assignee | ||
| phone: 954-726-9501 | fax: 775-665-5799 | email: lotatalk@bellsouth.net |
| AFFILIATE ID | AFFILIATE NAME | PHONE | FAX | |
| LAST NAME | FIRST NAME | COMPANY | DATE | |
| ADDRESS | CITY | STATE | ZIP | |
| PHONE | FAX |
| Pro. Code SERVICE Description | Cost | QTY | Total |
| 1000I 1000 min (5.9¢ pm) 30 days | $59.95 per line | ||
| 2000I 2000 min (3.4¢ pm) 30 days | $69.95 per line | ||
| 3000I 3000 min (2.9¢ pm) 30 days | $79.95 per line | ||
| 4000I 4000 min (2.2¢ pm) 30 days | $89.95 per line | ||
| Countries Australia. Austria, Belgium, Canada, Denmark, Finland, France, Germany, Hong Kong, Ireland, Italy, Japan, Mexico City, (ONLY), Netherlands, New Zealand, Norway, S. Korea, Singapore, Spain, Sweden, Switzerland, UK, USA | |||
| ACTIVATION One Time Charge | $15 per line | ||
| GRAND TOTAL | |||
| Pro. Code | Phone Number | Pro. Code | Phone Number | ||||
| _______: | _______- | _________- | _________ | | ________: | _________- | ________- | __________ |
| _______: | _______- | _________- | _________ | | ________: | _________- | ________- | __________ |
|
SERVICE AGREEMENT and CUSTOMER APPROVAL
| |
|
This service agreement is for flat rate phone service available in the contiguous 48 US states with ability to call in the 48 US States to 22 countries listed with prepaid monthly fee (NO per minute charges) for normal business or residential phone use, *special pricing available for heavy volume users. Lines include: toll free access, three way calling. Lines subject to the following restrictions: service is for normal voice. No Internet access, faxing, 900# or other billable calling. No sharing or resale. Violation of any of the above terms is considered fraudulent use and all services will be immediately terminated without notice or refund. Eliminate toll calls and Long Distance calls 24 hours, 7 days, taxes included. The service is valid for 30 days. NO ANNUAL CONTRACT OR ADDITIONAL FEES are required for service.
I, the undersigned, hereby agree to accept from LOT A TALK, LLC the above chosen flat rate calling service (s). I hereby authorize LOT A TALK, LLC to debit my credit or debit card for the set up fee and the first month's service fee. My account will be debited 7 days prior to the 30th day renewal date of my service. I understand the Service Agreement provided by LOT A TALK, LLC or it's designated service providers, under the general terms and conditions of the service set forth herein. I understand that LOT A TALK, LLC is not responsible for providing the actual long distance service and further agree to hold them harmless for not only any problems or causes associated with the network but also any liable situations that result from not being able to access the network. I further verify that all information provided herein is accurate and correct. I understand that LOT A TALK, LLC reserves the right to change or cancel these services and/or pricing at its' option. Further, I understand that I may cancel this service upon giving written notice to LOT A TALK, LLC at the address shown above. Such cancellation will terminate my services on or before the 30th day renewal date that occurs after the notice is received at the address above. My service will be terminated on the day after the 30th day renewal date if I fail to pay as agreed. I understand that there will be no credits or refunds. | |
| ______________________ | ___________________ |
| CUSTOMER SIGNATURE | DATE |
|
PAYMENT INFORMATION
| ||
| CREDIT/DEBIT CARD NUMBER__________________________ | EXPIRATION DATE________ | |
| Print FULL name as it appears on the Card: _________________________________________ | ||
| Provide Billing address for the Card:_______________________________________________ | ||
| Phone______________________ | Fax___________________________ | Email_____________ |
| IMPORTANT: Credit card will be processed by; SGS Marketing, LOT A TALK, LLC or assignee | ||
| ACCOUNT HOLDER: ________________________________________________________ | ||
| PHONE #: _______________________________ FAX#: ____________________________ | ||
| ADDRESS: ________________________________________________________________ | ||
| CITY: _____________________________STATE: ______________ ZIP: ______________ | ||
|
Institution information:
INSTITUTION NAME: _______________________________________________________ | ||
| CITY: ___________________________ STATE: ______ ZIP: _______________________ | ||
| TRANSIT/ABA #: __________________ACCOUNT #: _____________________________ | ||
| Applicant: | ||
|
NAME (s) ________________________________________________________________ (Please Print) SIGNATURE (s) ____________________________________________________________ | ||
| DATE ________________________ Phone #__________________________ | ||
|
Registered AFFILIATE:____________________________________________________ *Important: Please attach a void check if a checking account is selected. | ||
|
Make check payable to:
LOT A TALK, LLC |