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Order Form
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Name:
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Mailing Address:
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City:
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State / Zip-Postal Code and Country:
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Phone Number:
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Email:
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SS# or Tax ID:
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Date:
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1. Select the package you are ordering:
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Check off your choice below.
Paid Support Line
Includes 1 Extension
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Package
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Setup Fee
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Live
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$799
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Recorded
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$799
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This is a one-time setup fee with a $50 per month maintenance fee per line. No long term monthly contracts - you may cancel anytime without penalties.
For Multiple Extensions / $125 each additional.
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Package
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Price
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Extensions
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Setup Fee
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Live
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$799 + $125
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2
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$924
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Live
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$799 + $250
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3
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$1,049
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Live
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$799 + $375
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4
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$1,174
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Live
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$799 + $500
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5
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$1,299
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This is a one-time setup fee wtih a $70 per month maintenance fee per line. No long term monthly contracts - you may cancel anytime without penalties.
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2. Select the Billing Rate:
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This is the price you'd like to
charge callers.
Circle your choice below.
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PER MINUTE
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$.99 PER MINUTE
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$1.99 PER MINUTE
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$2.99 PER MINUTE
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$3.99 PER MINUTE
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$4.99 PER MINUTE
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$5.99 PER MINUTE
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FLAT RATE
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$10.00 PER CALL
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$15.00 PER CALL
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$20.00 PER CALL
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$25.00 PER CALL
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$30.00 PER CALL
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$35.00 PER CALL
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$50.00 PER CALL
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$75.00 PER CALL
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3. Enter the Forwarding number/s:
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(FOR LIVE PACKAGE ONLY)
Extension #1 - Forward to this phone
number: _________________ (INCLUDED FREE)
Extension #2 - Forward to this phone
number: _________________
Extension #3 - Forward to this phone
number: _________________
Extension #4 - Forward to this phone
number: _________________
Extension #5 - Forward to this phone
number: _________________
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4. Payment Information:
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Total Enclosed:
$_____________
Payment Method:
Money Order
Certified / Bank Check
Credit Card
Personal Check (takes 3-5 additional business days to
process)
Credit Card Info:
Visa
Mastercard
Discover
Name:
Billing Address:
Credit Card Number:
Expiration Date:
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Please make your check or money order payable
to:
FutureQuest Marketing, Inc.
Attn: New Accounts
3003 Yamato Road, Suite C8-1063
Boca Raton, FL 33434
Credit Card Orders May be mailed or Faxed to
(561) 423-9298
Phone Orders/Questions (888) 227-6135
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Signature:
___________________________ Date:
_______________
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