PHONE CARD HOTLINE FAX BY CHECK FORM

Fax this form along with a voided check to 1-440-526-4332. The undersigned hereby authorizes Phone Card Hotline to issue FAX Check (Bank Drafts) for payment of wholesale calling cards, telecommunications services and other products and services. The undersigned understands that each susequent Bank Draft payment shall be individually authorized by phone, fax or by email by giving the check number of an unused check from the bank account below . I further understand and agree that I shall pay to Phone Card Hotline a fine of $25.00 plus bank charges for any Bank Draft returned NSF. Bank Drafts and "Telephone Checks" are a legal method of payment as provided by the Uniform Commercial code, Title 1, Section 1-201 (39) and Title 2, Sections 3 - 104, 3-401 and 3-403, code of Federal Regulations, Title 12 Chapter 11, Part 210 and Regulation J Federal Reserve Bank, Part 2, Sections 4a-201, to 4a-212 and in U.S. Law in Romani V Harris 255 Md. 389. Company Information Company Name: __________________________________________________ Address: _______________________________________________ City,State,Zip: ________________________________________________ Authorized By: ________________________________________________ Signature: ________________________________________________ Title: ___________________________Date:________________ Bank Information: Bank Name: _____________________________________ Branch Phone: ___________________________________ Bank Contact: ___________________________________ Bank ABA # _____________________________________ Account #: ______________________________________ Please attach a copy of a voided check for Phone Card Hotline records. The undersigned hereby authorizes the following credit card to be used at the discretion of Phone Card Hotline for payment of shipping and handling fees, and as a guarantor for any NSF returned checks.  Any returned check (including $25 NSF fee) may automatically be charged to the credit card below  without further notice. Master Card Visa Card Number _______________________________  Expiration Date __________________ Name as printed on credit card ____________________________________________ Credit Card Billing Address _______________________________________________ City ______________________________  State __________   Zip _______________ Signature of card owner _________________________________________________