=======WEB-FAX SERVICE APPLICATION FORM==========
To apply for the Web-Fax service please print this form out through
your browser and fill out all the necessary information. Upon completion fax
your application to World-Link Communications at USA number +1 508 370 7791.
74 Main St. Framingham, MA 01702 USA Telephone: +1 508 370 7778
1) Company Details: ------------------- Company Name __________________________________________ Contact Name __________________________________________ Title __________________________________________ Address __________________________________________ City __________________________________________ State / Province __________________________________________ Country __________________________________________ ZIP /Postal Code _____________________ TEL Number _____________________ FAX Number _____________________ 2) Users Details: ----------------- User Name User Email Address Alternate Email Address -----------------|-----------------------|--------------------------- _________________|_______________________|___________________________ _________________|_______________________|___________________________ _________________|_______________________|___________________________ _________________|_______________________|___________________________ _________________|_______________________|___________________________ _________________|_______________________|___________________________
3) Credit Card Details: -----------------------
Credit Card Type [] Visa [] Master Card [] AMEX [] Diners Card Expiration Date MM/YY _______________________ Credit card Number ________________________________ Card Holder Name _________________________________ Card Holder Tel. Number ___________________________ Card Holder FAX Number ___________________________ 4) Statement of Authorization: ------------------------------
I hereby agree to pay World-Link Communications, Inc. the prevailing rates for the WEB-FAX Service usage, and understand that a minimum usage charge of US$ 25.00 per month will be applied to my credit card designated above. This AUTHORITY shall remain in effect until World-Link Communications, Inc. receives a written notification from the undersigned to cancel this authority. I understand and accept all liability for payment of all charges resulting from using the WEB-FAX Service regardless of whether the service is used by myself or any of the users listed on this application form. Name: __________________________________________ Date: __________________________________________ Signature: _____________________________________Your application will be processed immediately upon arrival and you will receive
your WEB-FAX PIN number within 24 hours.===============================================================