Telephone Bridge Services is a division of TeleClass International
Bridge Lease Application and Credit Card Information
(218) Bridge Lease

FAX-able Credit Card Information. Do not send sensitive information through e-mail.

PRINT THIS PAGE AND FAX TO:
Rebecca Hanson at: 561.828.3786
NOTE: This transaction will be billed on your credit card statement as TeleClass International.

First name: ___________________________

Last name:____________________________

Address:______________________________

City:__________________________________

State/Province:________________________

Zip/PostalCode:_______________________

Country:______________________________

Phone:_______________________________

E-mail: _______________________________
(So you will get a receipt)

Leases begin immediately upon payment of first monthy payment

Bridge Size	Monthly
25-person	$100/month
50-person	$150/month
100-person	$200/month
300-person	$250/month
600-person	$300/month

Canadian Residents NOTE: GST will be added to total

Name on Credit Card: (Print)

______________________________

Card Number: (Print)

______________________________

Expiry Date: MM/YY

______________ ___________

Cancellations require a two-week notice prior to the next monthly payment

Bridge leases will receive new PIN numbers upon request.

Bridge size may be INCREASED, but not decreased.

There are NO refunds on unused portions of the lease period