Voice Mail Box Setup Sheet

Please provide the following contact information:

First name
Last name
Middle initial
Title
Organization
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country
Work Phone
FAX
E-mail
URL

Please charge the following credit card with the monthly rental fee ($10/month) for a Voice Mail Box:

American Express
MasterCard
VISA

Enter your name as it appears on your credit card in the space provided below.

Enter your credit card account number in the space provided below.

Enter the expiration date in the space provided below:

Your credit card will be charged monthly. Kentucky sales tax will be added if applicable. Submitting this form authorizes this method of payment, or if you prefer to mail in this form, enter your signature in the space provided below to authorize this method of payment.

Would you like pager notification at an additional cost ?

Yes No