Telephone Bridge Services is a division of TeleClass International
Bridge Lease Application and Credit Card Information
FAX-able Credit Card Information. Do not send sensitive information through e-mail. 

PRINT THIS PAGE AND FAX TO:
Gizelle River: 248.484.6543
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:

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

$200
$2,400
$600

100-person

$275
$3,300
$825

25-person
Double Security

$150
$1,800
$450

Other

$_______

Referred by:
__________________________________________

  • 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

 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

Office Use Only

 

Bridge number: _________________ P.PIN_______Mod PIN______

# of lines________Start date_____________End Date____________

Quarterly rate:_________________Recurring set up?  

Yes by___________

In the event a Leased Telephone Bridge experiences technical difficulties which render it inoperable, TeleClass International will:
1. Offer a replacement bridge
2. Or upon written request to discontinue service completely, we will put a stop on further quarterly payments.

This policy only applies when a Bridge is technically inoperable.