New Long Distance Subscriber Signup
Personal Information
First Name:
Middle:
Last Name:
Company:
Address:
Address 2:
City:
State:
Zip:
Country:
Phone Number:
-
-
Billing Information
Subscription Term:
*** Choose One ***
West Michigan Plan $4.95 / Month (231, 269, and 616 Area Codes)
National Plan $14.95 / Month (48 States)
West Michigan Plan $14.85 / 3 Months (231, 269, and 616 Area Codes)
National Plan $44.85 / 3 Months (48 States)
Billing Type:
Credit Card:
Check:
Check Fee:
Your account will be activated when we receive your payment.
(Add $3.00 Fee for Monthly Paper Billing)
Does not apply to quarterly, semi, or annual accounts.
Credit Card Number:
-
-
-
Exp Date: (ex: MM/YEAR)
/
Credit Card CVV Number
(3 Digits on the back of the card):
Home Phone Information
You must dial your
local Access Number
before every long distance call you make in order to avoid long distance charges from your phone company.
From what phone number will you be using the service? (XXX-XXX-XXXX)
Marketing Information
Your email addres? (Optional)
How did you hear about us?
What is your Internet Service Provider? (Optional)
I have read and I agree to the terms and conditions in the Triton Technologies
billing
and
use
policy.
(Check to agree)
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