Phone Conferencing Sign Up Form

Please print out the following form, fill it in, sign and fax it to 312.245.1128, attn: Gary Parker.

Name_________________________Company_____________________________

Street Address_______________________City and State ___________________

Zip__________Phone_______________Email_________________________

We would like to be set up to experience the ICI/Confertel phone conferencing experience. I understand that we will receive 300 free minutes applied against our first conferences.  There are no contracts so we will continue using the system at our pleasure. As the representative of the company using this toll free number which access the ICI/Confertel conferencing center I assume responsibility for payment against my credit card for all calls made using my toll free number if that card is used in payment rather than direct billing.  I will receive an invoice showing total calls, total minutes for each participant and the time and date of each call along with each participant’s entry and departure time from the conference.

For any questions on billing, I can phone 800-376-6654.

Signed_________________________________Date____________________

Credit Card: (Visa, MasterCard, and Discover)

Card Number:______________________________Exp: Month___Year_______

Address of card holder with city, state & zip________________________________________

___________________________________________________

Please fax to 312.245.1128

Thank you. We will send confirmation to your email or fax address. Please allow two days to obtain your number, install you on the system and be up and running.