|
GlobalPhone Corp .Callback Service Application for Corporate Accounts Please print this form and fax or mail all pages of your application to:
Account Information:
Call Back Phone Number Information:Enter the phone number that the call-back system should call back to, as if dialing from the U.S. Space for five callback numbers is shown below. If more are needed, please list additional numbers as required on a separate sheet.
|
Please circle the language you prefer for your voice prompts.
| English | German | Spanish | French | Japanese | Chinese(Mandarin) | Korean | Russian | Portuguese |
Method of Payment
There are three methods of payment: credit card, purchase order, or prepayment. Please select the method of payment and complete the application below.
1. Purchase Order
Government offices, embassies and major corporations may open an account with GlobalPhone and pay upon presentation of an invoice from GlobalPhone. An invoice with a complete listing of every call and the cost of each call will be faxed to you at the end of the month. Payment must be made upon receipt of invoice. Please note invoiced accounts with less than $10 in monthly usage will be billed a flat rate of $10 for processing fee. All payment must be made in US dollars drawn on a US bank. Please attach a purchase order to your application or provide your reference number.
Reference Number or Purchase Order:
| Reference Number or Purchase Order Number: | Date: |
2. Credit Card Payment
Charges will be billed against the credit card once each month for actual usage incurred. A complete listing of the calls made and the charge for each call will be mailed at the end of each month. GlobalPhone may obtain a credit card authorization for the estimated usage amount, but will only charge for actual services, after they have been rendered. In the event that the credit card becomes invalid, the customer must provide GlobalPhone with a valid credit card number or pay all outstanding debts by check or cash.
Credit Card Information: |
|
Credit Card Number: |
Expiration Date: |
Name on Card: |
Card Issuer: |
3. Prepayment
Checks drawn on US banks are accepted by GlobalPhone. If you have a bank account in the U.S., payment can be made by mailing the Callback Service Application along with a check made payable to GlobalPhone Corp.. You may also wire transfer money to: Wachovia Bank
SWIFT bank number CFBRUS33, Routing Number: 051000253, GlobalPhone Bank Account number: 1841327778. A credit equal to the amount of money prepaid will be established for telephone usage.
Western Union Money Transfer Procedure:
| Use the blue "Quick Pay" form Company Name: GlobalPhone Locale/Code city: GPHONE VA Fax copy of Quick Pay form receipt to 703-531-6000 with your account number if you have one already. |
Agreement:
I agree to pay and specifically authorize
GlobalPhone Corp. to charge for long distance telephone service. I agree to pay all
outstanding balances owed to the GlobalPhone. Disputes must be made in writing, via mail
or fax no later than 30 days after receipt of invoice, to Customer Service 137 N.
Washington Street, Falls Church, VA 22046, USA. Tel: 703-533-2122, Fax:
703-531-6001.
| Authorized Signature: | Date: |
| Print Name: | Title: |
|
|