Custom900.com - Ordering by mail

Custom900.com is now PayPerCall.com!
Click here to visit our new site.

PRINT THIS FORM, SEND IT BY MAIL OR FAX.
Send it to us completed, along with your payment for quick service.
We will expedite your order(s) immediately!
Allow 5-7 business days for setup.
Feel free to call us at (888) 227-6135 or by FAX: (561) 423-9298

900 Number Custom Line Package
Order Form

Name:

Mailing Address:

City:

State and Zip Code:

Phone Number:

Email:

SS# or Tax ID:

Date:

Please select the number of 900 lines that you would like to order,
by filling in the quantity below:

____ Custom Live 900 - $1.99 per minute - $799

____ Custom Live 900 - $2.99 per minute - $799

____ Custom Live 900 - $3.99 per minute - $799

____ Custom Live 900 - $4.99 per minute - $799

____ Custom Live 900 - $10.00 FLAT RATE per call - $799

____ Custom Live 900 - $15.00 FLAT RATE per cal l- $799

____ Custom Live 900 - $20.00 FLAT RATE per call - $799

____ Custom Live 900 - $25.00 FLAT RATE per call - $799

____ Custom Live 900 - $34.95 FLAT RATE per call - $799

____ Custom Recorded 900 - $1.99 per minute - $799

____ Custom Recorded 900 - $2.99 per minute - $799

____ Custom Recorded 900 - $3.99 per minute - $799

____ Custom Recorded 900 - $4.99 per minute - $799

____ Custom Recorded 900 - $10.00 FLAT RATE per call - $799

____ Custom Recorded 900 - $15.00 FLAT RATE per call- $799

____ Custom Recorded 900 - $20.00 FLAT RATE per call - $799

____ Custom Recorded 900 - $25.00 FLAT RATE per call - $799

____ Custom Recorded 900 - $34.95 FLAT RATE per call - $799

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:

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 (516) 620-3049

Total Enclosed $________

Questions and Orders:
Email: info@paypercall.com
(888) 227-6135