License Service Agreement / Terms of Use Account Set Up

Credit Card Payment Form | Check Payment Form

Organization
Name:
ACCOUNT NAME or ADMINISTRATOR:
* Required
*First Name:
*Last Name:
*Address 1:
Address 2:
*City:
*State/
Providence
*Zip Code:
(P.C)
*Country:
USA Canada
*Time Zone:  
Eastern Central Mountain
Pacific Atlantic  Alaska
Hawaii
* 10 Digit Phone*:
* 10 Digit Cell:
10 Digit Fax:
*Email:
USA: Tax Exempt:
No
Yes**
Purchase
Order #:


* I Accept the Terms as set forth in this License Service Agreement Terms of Use. Terms
 I decline. Return to home page.

Plan Selection:
*Term:
(in months):		 4 6 12
*Maximum
Phone #s:		 25 50 75 100 Other*
*Message
Length:
(in seconds)		 30 45 60 Other*
*Add
Caller ID: 		 Yes No Use Phone Number:
*Number of
Teams:
*Contract
Dates: 		Start Date: End Date:
Please only order Plans available from the Pricing Table on the Pricing Page
+ Minimum renewal pricing subject to past use,
Caller ID is renewable per order.
Custom Plan Detail / Proposal Number / Comments:*
Reseller Agency Information:
Agency :
Key #:
Sales Person:
Credit Card Payment:
*Total Amount:
*Name on Card:
*Card type:
Visa Mastercard
*Account # (No Hyphens):
*CVC:
*Exp. Date:
Card holder's Address and Contact Information
*Address:
*City:
*State/Prov.:
 *Zip Code (P.C.):
*Email:
*10 digit Phone:
We process credit cards off line, and send you via email a paid receipt.
Please view your email for additional instructions on setting up your name and numbers,
or click the Excel Template link on the next page after you submit this form
to send us your names and numbers, or go to FAQ and click Excel Template

Azzini Communication, LLC • Coaches Call 7235 Algonquin Dr. • Cincinnati, Ohio USA 45243 PH 513-745-8900