orderform
Service Agreement #: |
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Customer Information | |
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Business Name: | Contact Name: |
Current Address: | Email Address: |
Contact Number: | Cell: |
Current Account Number: |
LONG DISTANCE | ||||
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A- | B- | C- | D- | |
E- | F- | G- | H- | |
441- | 441- | 441- | 441- | |
441- | 441- | 441- | 441- |
PAYMENT TYPE/CREDIT INFORMATON | |||
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Payment Type: | Invoice | Bank Transfer | Credit/Debit Card |
Card Type: | Visa | Master | Amex |
Name: | |||
Credit/Debit Card: | Exp. Date: | ||
AUTHORISATION | |
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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 | |||
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New | Upgrade | Replacement | Other |
