Click here to order now via e-mail or Print& Fill
out Service Authorization Form, sign it and
+46(0)8-915770. Mailing
address: Xtelecom®Inc.
BOX 763. 120 02 ÅRSTA. SWEDEN
Your
Name /Company/ Organization /Business _________________________________________________
If this is a business subscription enter your VAT number
: ________________________________________
If this is a residential subscription; Enter Social Security Number _____________________________________________
Billing Address _______________________________ Postal
Code _______________ City
_________________________
Country __________________________________________
Contact Person (if business subscription) : Name ___________________________________________
Title: Mr Mrs Miss
Ms Dr. Other title ______________________________________
Contact phone number ___________________________ Fax
________________________________
E-mail address ( for quicker response) ____________________________________________________
Select service(s)
| Use
separate space if your number listing is longer than space available
Postgiro
or Bankgiro is the method of payment for
our Direct Dial Access service form Sweden
This applies only for calls made from land phones.
For callback service please fill out information of
your credit card below.
Credit Card Type:________________________________
Number:_______________________________________
Expiration Date: (mm-yy) ________________________
Card holder(As on card):__________________________________
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from)
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Service
Authorization.
Undersigned customer hereby requests Global Access International
Long distance service(s) from Xtelecom Telemäklarna. If this service
order is granted and either Credit card or Giro/Cheque/Wire transfer is the
payment method, Customer authorizes Xtelecom to either charge the above listed
Credit card number or to send invoice payable to Xtelecom for all charges attributable
to the services ordered. If credit card billing is selected, the undersigned
understands that the same terms and conditions normally governing the use of
the credit card apply to this use as well. Customer authorizes Xtelecom and
its agents to perform credit checks and to investigate the bank references and
other credit or financial information or references submitted to Xtelecom, where
permitted. The undersigned represents that he/she has authority to request Global
Access service(s) for the customer, that he/she understands rates are subject
to change without notice. All transactions are subject to our general conditions
which will be sent to you at your request
Print Name Authorized
Signature:
Date