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Please print the application (help below)
or download it in MS Word format ( RTF format): Cbapp.rtf
Then sign and return by mail or fax completed form to the nearest office:
|
International Applications: 4747 East Elliot Road Suite 29-490 Phoenix, Arizona 85044 USA Ph: +1 480 491 8317 Fax: +1 480 491 8375 |
New Zealand Applications: Private Bag MBE N321 New Market Auckland 1001 Ph: +64 9 529 2231 Fax: +64 9 5299531 |
In order for this application to be processed efficiently, it is very important
that it is completed clearly and in full.
CUSTOMER INFORMATION
First Name Please print your full name
Family Name: Please print your Family name in full
Company: For use when using a company name.
Address: Usual mailing address.
Telephone: Daily contact number (with country and area codes)
Billing address: Use if other than mailing address
ACCOUNT INFORMATION
Cust tel#1: --
Is the telephone number you wish to have OWC callback applied to. Please give your number as a person from overseas would dial it ie. 64-9-483-8154 Please indicate with a tick if it is Voice Fax or Mobile.
Monthly Credit Limit --
Is the MAXIMUM amount (in US dollars) you estimate you will use per month on each line, with a minimum of US $50 (This is NOT a US $50 minimum billing, you only pay for what you use)
CREDIT CARD / PAYMENT INFORMATION
Credit Card No: ---
Complete no. in FULL VERY CLEARLY
Expire Date: --
The date the card is due to expire MUST NOT be less than 45 days.
Card holders name --
Print name as it appears on the card (Please tick appropriate box to indicate type of card)
Note:
Any errors with credit card details will result in decline by the credit card Company and delay with the processing of this application.
AUTHORIZATION
$________
This is your total estimated monthly credit allowance (in US dollars)
This allowance is not withdrawn from your account in advance, however it is set aside for the specific purpose of meeting payments of actual callback use, on a weekly basis.
One yearly administration fee of US$29 will be withdrawn from the card in the first billing period. One administration fee covers any number of phone lines on the OWC callback including cell phones, provided they are all at the same location .
Complete Authorization with name , signature and date
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