Intercall Conferencing Order Form

Customer Order Info

Required fields are marked with a "*"

*Customer Name (Business name if business account)
This must match the name on your local phone bill.

*Customer Email Address

Must be correct to set up account.

Service Address... The following address must match the address at which you receive your phone bill

*Address Line 1

Address Line 2

*City

*State

*Zip

Subscriber Information...

*Subscriber Phone

Contact FAX (leave blank if none)

*Subscriber Name

*Subscriber Title

*Main Telephone Number: [i.e. 2102223333]

Comments:

I hereby authorize Intercall (IC) to act as my teleconferencing provider.

I hereby authorize IC to check my credit history to determine our credit worthiness for the estimated teleconferencing usage and service charges as applicable. I understand that teleconferencing services will not be provided if credit is not extended on this account.

I Agree to the above terms YES

Your TCP/IP address has been registered to verify your agreement to the above terms.