ECCG for Business Order by Fax Form Important: Read the User Agreement before ordering. Print this Page and Fax to 619.582.4616

Quantity Description Price Total (1) Executive Custom Corporate Service: All fees & charges are required to be prepaid by a company issued credit card unless terms have been established and approved. Note:12 month renewable term contract. Early termination fees apply. ________ *300 Operator Message Bucket $255.00 prepaid bulk message ________ ________ *MLF -- Monthly Line Fee $19.95 X 2 ( Current month plus next month) ________ ________ *MBF -- Monthly User Base Fee $12.95 x 2 x EACH user extension ________ (2) Service Activation Fee: ________ Toll-free Line Activation $50.00 Per Line (non-refundable) ________ ________ User Extension Activation $12.95 (Per User Extension (non-refundable) ________ Sub-total: ________ ________ Port Fee(s) $50.00 Per Line (non-refundable) ________ Enter Quote Total Here Total: ________

**** ORDERING INFORMATION ****
Bill To:
Fill-in all blanks. Please print clearly.
Company Name:_____________________________________________Order Date: ____________
User Names: Add a separate list for your employees with linking email or text addresses.*
Company Address:_________________________________________________________________
Billing Address:_________________________________________________________________
City/St/Zip:______________________________________________________________________
Company Phone#:________________________________________________________________________
Company Fax#:__________________________________________________________________________
Company Email:__________________________________________________________________________
Contact Name:_________________________________________________________________
Contact Phone#:_________________________________________________________________
*Linking Information: Please provide the following information for each employee on a separate sheet of paper or Excel spreadsheet.
Linking Device Type (i.e. Cell, Blackberry, Pager, etc):_____________________________________
Carrier Name (i.e. Cingular, Sprint, etc):___________________________________
Device PIN number:________________________________________________________ For Blackberry only upon request by your network provider.
Email Address ( No Text Addresses):____________________________________________________________
. Authorized Signature:__________________________________________________ Date: _____________ Tel/Email (if different from above)_____________________________________________________
By activating the Service: (i) you acknowledge that you have read and understood, and you agree to the terms and conditions of this Agreement; (ii) you represent that you are of legal age to enter this Agreement and become bound by its terms; (iii) you are authorized by your company to enter into the agreement. Important: Read the User Agreement before ordering.

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