orderform

Hello, world!
Service Agreement #:
Customer Information
Business Name: Contact Name:
Current Address: Email Address:
Contact Number: Cell:
Current Account Number:
LONG DISTANCE
A- B- C- D-
E- F- G- H-
441- 441- 441- 441-
441- 441- 441- 441-
PAYMENT TYPE/CREDIT INFORMATON
Payment Type: Invoice Bank Transfer Credit/Debit Card
Card Type: Visa Master Amex
Name:
Credit/Debit Card: Exp. Date:
AUTHORISATION
I have read terms and conditions, which are available at www.onecomm.bm and I agree to be bound by and to abide by the terms and condition that apply to the service plans that i have selected.
Print Name of Company Representative:
Signature: Date
Print Name of Customer:
Signature: Date
INTERNAL USE ONLY
New Upgrade Replacement Other