ORDER FORM FOR FAX, MODEM, AND/OR CREDIT CARD LINES

Please fill in information below, a representative will contact you to discuss your order regarding carriers and rates. We will then fax you an order form to sign. This order will not be confirmed until a signed copy of the order is received by Telesis Communication Services.

Company Name:
Contact Name:
Street Address:
Suite/Floor
City:
State: Zip Code:
Phone Number: Fax Number:
E-mail Address:
Location of Demarc:
Date Needed:
   
Please enter the number of new lines needed for each of the following:
Fax
Modem
Credit Card

 Alarm
Other
KEEPING EXISTING NUMBERS? PLEASE LIST NUMBERS TO SWITCH TO NEW CARRIER

1. 2.

3. 4.

 

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