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SERVICE REQUEST

See your teleconferencing services sign-up form below

Please complete all required items and click submit

Internet Special Direct Rate of
5.9 cents per minute (USD$) per caller
for Toll free service for all of the USA and Canada

(NOTE: CLICK HERE IF YOU PREFER TO PRINT AND FAX YOUR SERVICE REQUEST)

NOTE: Click Submit once to send your Information

1) During normal business hours you will receive a welcome email within 60 minutes that includes: all conferencing numbers, passcodes and simple directions to use our services.

2) If we need to verify any requests you have made, we will call to confirm.

3) Use your service anytime without the need to make a reservation.

All Items marked * must be completed - Leave others blank if not applicable
Note - All items marked * must be completed

Company or Account Name *
Account Billing Street Address *
City *
State or Province *
Zip or Postal Code *

Service Contact First & Last Name *
Service Contact Title *
Service Contact Telephone# *
Service Contact e-mail address *
Billing Contact First & Last Name *
Billing Contact Telephone# *
Billing e-mail address *
Maximum # of expected callers ? *

Toll free Reservationless ?	Yes No
Toll Call Reservationless ?	Yes No
International Toll Free Numbers ?	Yes No
Operator Assisted ?	Yes No
Web or Video Conferencing Needs ?	Yes No
Event Call Services ?	Yes No
Please insert Moderator names (Info can be given at a later time)
Please insert any comments or Special Needs
Billing Request * We will call for any additional needed billing information	(A) Bill to Credit Card Yes OR (B) Set up Net 30 day billing Yes
Promo Code (if applicable)

TERMS AND CONDITIONS:

I hereby certify that the above information is true and correct and A+ Conferencing has my permission to use this information for credit checking purposes. If credit is extended to me, I agree to pay my invoices promptly within the terms stated on the invoice. I agree to pay the invoice in its entirety including all taxes and fees associated. If I default in meeting these conditions, I understand that A+ can place my account on a credit hold status, which means my company cannot use any more A+ services until payments are made to restore my account. I am responsible for all usage of my pin codes, therefore I will keep the codes confidential to prevent any unauthorized usage on my account. If I do suspect any unauthorized usage, I will report it to Customer Service immediately at 888-239-3969. A+ Conferencing reserves the right to change conference numbers if necessary for operational purposes. If at any time I wish to cancel my account, I will send the request in writing to cancellations@nwpros.com. A+ Conferencing reserves the right to change conference numbers if necessary for operational purposes. For a list of additional terms & conditions, please visit www.aplusconferencing.com.

I have read the terms and conditions *

Yes

Name *

Please complete all items marked before submitting

Submit only once - We normally reply within 2 business hours

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