Telephone Bridge
Services is a division of TeleClass International PRINT THIS PAGE AND FAX
TO: First name:
___________________________ Last
name:__________________________ Address:___________________________ City:______________________________ State/Province:_____________________ Zip/PostalCode:_____________________ Country:___________________________ Phone:____________________________ E-mail:
_______________________________ Card
information: Application
for a ONE-YEAR BRIDGE LEASE
25-person
50-person
100-person
25-person
Other $_______ Referred
by: 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 Bridge
number: _________________ P.PIN_______Mod
PIN______ # of
lines________Start date_____________End
Date____________ Quarterly
rate:_________________Recurring set
up? Yes
by___________ This policy only
applies when a Bridge is technically
inoperable.
Bridge Lease Application and Credit Card Information
FAX-able
Credit Card Information. Do not send sensitive information
through e-mail.
Gizelle River:
248.484.6543
NOTE: This transaction will be billed on your credit card
statement as TeleClass
International.
In the event a Leased Telephone Bridge experiences
technical difficulties which render it inoperable, TeleClass
International will:
(So you will get a receipt)
Payments will be made Quarterly
Double Security
__________________________________________
1. Offer a replacement bridge
2. Or upon written request to discontinue service
completely, we will put a stop on further quarterly
payments.