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

PRINT THIS PAGE AND FAX TO:
Rebecca Hanson: 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) Card information:  Name on card:_________________________ Card Number: __________________________ Card Type: Visa MasterCard AMEX Discover Debit card Expiration date: _______Month _________Year Amount to be charged:  $__________________ Quarterly X______________________________________ Your Signature

Application for a ONE-YEAR BRIDGE LEASE Payments will be made Quarterly Bridge Size Monthly Rate Yearly Rate Quarterly Payment 25-person $100 $1,200 $300 50-person $150 $1,800 $450 100-person $200 $2,400 $600 200-person $300 $3,600 $900 Other: request a quote Web Presenter?  Canadian Residents NOTE: GST will be added to total Leases begin immediately upon payment of first quarterly payment Four quarterly payments will be processed at the beginning of each quarter Cancellations require a two-week notice prior to the annual renewal date. (We will email you to confirm your intentions) Renewed annual 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

This policy only applies when a Bridge is technically inoperable.