Total Recall Message Center, Inc.

Alpha Dispatch Service Contract


To begin the process of applying for Live Alpha Dispatch Service, please answer the following questions. Your attention to detail at this stage will result in much more efficient and effective service.  Please note that some answers are REQUIRED in order to establish service.

 
Owner Name
Physical Address, City, State, ZIP Code
Billing Address, City, State, ZIP Code
E-mail Address of Contact Person
Business Federal Tax ID (EIN) (or Social Security Number for individuals or sole proprietorships)
Main Published Phone Number (including Area Code)
Secondary Phone Number or Toll-Free Number
FAX Telephone Number
Please give details on how you heard of us:
Date you would like service to begin
Will you be using a Toll-Free Number? Yes -- provided by Total Recall
Yes -- we already have one 
Not at this time
How will your activations be submitted toTotal Recall?
 Activations by Fax 
Activations by E-Mail 
Activations by phone (extra charge)
CARRIER INFORMATION
Please use the following sections to provide a COMPLETE LIST 
of all Carriers you resell for.
Carrier Number 1 Name
City/State
Modem Number (with Area Code)
Carrier Number 2 Name
City/State
Modem Number (with Area Code)
Carrier Number 3 Name
City/State
Modem Number (with Area Code)
Carrier Number 4 Name
City/State
Modem Number (with Area Code)
Carrier  Number 5 Name
City/State
Modem Number (with Area Code)

For Additional Carriers, please submit information in the box below
or by Fax to your Communications Consultant

IMPORTANT
By initiating or subscribing to and using the services of Total Recall, you agree to the Terms and Conditions as outlined on the Terms and Conditions Page. PLEASE REVIEW THIS INFORMATION before submitting your application, and click to place a CHECK MARK IN THE BOX below.

Please NOTE that Total Recall needs the information on this form prior to commencement of service. Procedures proposed by Subscriber are SUBJECT TO ACCEPTANCE by Total Recall

I have read and understand the TERMS AND CONDITIONS. I understand that by initiating or subscribing to and using the services of Total Recall Message Center, Inc.® I agree to be bound by these provisions. I further understand that for service to continue, I must PRINT OUT, SIGN and MAIL or FAX a signed copy of this Service Application to Total Recall's Office to be received not more than TEN DAYS from the date I submit this application on-line.
[Addresses and Fax Numbers are on the Home Page]

SIGNATURE ______________________________ 

Date _______________

Please PRINT name __________________________________

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