=======WEB-FAX SERVICE APPLICATION FORM==========

To apply for the Web-Fax service please print this form out through your browser and fill out all the necessary information. Upon completion fax your application to World-Link Communications at USA number +1 508 370 7791.
74 Main St. Framingham, MA 01702 USA Telephone: +1 508 370 7778

1) Company Details:
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Company Name      __________________________________________

Contact Name      __________________________________________

Title             __________________________________________

Address           __________________________________________

City              __________________________________________

State / Province  __________________________________________

Country           __________________________________________

ZIP /Postal Code  _____________________

TEL Number        _____________________
FAX Number        _____________________


2) Users Details:
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User Name            User Email Address     Alternate Email Address

-----------------|-----------------------|---------------------------

_________________|_______________________|___________________________

_________________|_______________________|___________________________

_________________|_______________________|___________________________

_________________|_______________________|___________________________

_________________|_______________________|___________________________

_________________|_______________________|___________________________

3) Credit Card Details:
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Credit Card Type  [] Visa     [] Master Card   [] AMEX   [] Diners

Card Expiration Date  MM/YY _______________________
Credit card Number ________________________________

Card Holder Name  _________________________________

Card Holder Tel. Number ___________________________

Card Holder FAX Number  ___________________________


4) Statement of Authorization:
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I hereby agree to pay World-Link Communications, Inc. the prevailing 
rates for the WEB-FAX Service usage, and understand that a minimum 
usage charge of US$ 25.00 per month will be applied to my credit card 
designated above.
 This AUTHORITY shall remain in effect until World-Link 
Communications, Inc. receives a written notification from the 
undersigned to cancel this authority. I understand and accept all 
liability for payment of all charges resulting from using the 
WEB-FAX Service regardless of whether the service is used by myself
or any of the users listed on this application form.


Name: __________________________________________

Date: __________________________________________

Signature: _____________________________________


Your application will be processed immediately upon arrival and you will receive
your WEB-FAX PIN number within 24 hours.

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