New Customer Application Form (we never provide information to any 3rd party)

Please provide accurate information. We need to verify the identity of each new customer. The only way to do this is to verify that the information on your checking account, and your credit card match the residential address and phone you give us. We need a personal reference and a work or business reference.  If you own a website, please let us know. It is very important to supply a listed phone number a verifiable address. If you ue a "free email, such as aol or yahoo or gmail, please also give us a verifiable ISP based email.

Please understand: We are a family run business and we take it seriously, but people have sent us fake checks in the past. We make it very easy for you to check us out.  We own our building, we have land based phones. Our website has been registered for more than 10 years and we will gladly give you the name and phone of a satisfied customer. If you do not want to send information over internet, you may print and fax the form to my private office fax: 440-201-6340

 Click Submit at bottom when finished.

Personal Information use your residence address here

* First Name

*Last Name

* Street Address

*City

*State

*Zip/Postal Code

* Phone		Cell Phone
* Email		Alternate E-mail

*Driver's License

* Personal Reference *Personal Reference's Phone

Tell Us About Your Employer.  If you have no job say "NA or Not Applicable"

Employer		Employer Phone

Employer Address
Employer Contact Name

Tell us About Your Business (Please use a physical address not a PO Box) if different than residence

Business Name		Business Phone

Business Address
Weekly Phone Card Sales
Your Web Site

Your shipping charges may be charged to your credit card to verify your credit card. If you do not own
a credit card, please tell us.

Name on Credit Card
Credit Card #
Expiration Date

3 digit Security Code		MC or Visa

Street Number

Zip Code

Checking Account information - The routing number located is between |:                    :| or fax us a copy of your check.

Name as printed on check
Bank Name
Routing Number
Account Number

Bus. or Personal Account		Check Number
		Other Notes & Requests

 

Copyright © 2003 [Phone Card Hotline]. All rights reserved.  - Revised: 05/12/09