Media Broker Membership
FAST RING ORDER FORM
Business Name
*
Business Address
*
Line 1
Line 2
City
State
Zip Code
Country
Setup Contact Person
*
First
Last
Phone Number
*
Title / Position
*
Email Address
*
4 Local Media Representative
*
PACKAGE INFORMATION
Pricing Information:
- Setup Fee (one time) $199
- Unlimited Minutes / Calls
- Minimum Agreement (3 months)
Multiple Location Discount:
SPECIAL PRICING CODE
1 location $999 per month (code discount = $699)
2-4 locations $899 per month (code discount = $599)
5+ locations $799 per month (code discount = $499)
Industry / Category
*
Automotive
Home Services
Retail Business
Medical Industry
Financial Services
Other
Number of Stores or Locations
*
1 location
2 locations
3 locations
4 locations
5 locations
More than 5 locations (special pricing)
This is the phone number that will be displayed to the customer’s phone
Phone Number
*
BILLING INFORMATION
Terms & Conditions: Business has the ability to set up unlimited of Fast Ring lead sources. Business login will be provided at setup. Fast Ring will set up first 5 chosen lead sources. FastRing.com is not responsible for the services or data fees that might be charged by telephone or data service providers as a result of participation of this program. FastRing.com is not responsible for dropped or missed calls as a result of network outages. Interruption of service or degraded service may occur at anytime and without notice. By entering into this agreement, I certify if I choose to enable call recording that I am located in a multi-party consent state and I agree to verbally disclose the call recording to consumers on all FastRing.com calls. This agreement is solely between FastRing.com and the business on this agreement. 4 Local Media is only the broker between both FastRing.com and the business on this agreement. Business understands all services are provided by FastRing.com
Name on Credit Card
*
First
Last
Signature
*
Electronic Signature
*
Yes I acknowledge this.
Email Address
*
Terms & Conditions
*
I have read and agree to the terms & conditions
Special Discount Code
*
Credit Card Billing Address
*
Line 1
Line 2
City
State
Zip Code
Country
Credit Card Type
*
VISA
Master Card
Discover
American Express
Credit Card Number
*
Expiration Date
*
CSV Code (3 digit code on back of CC)
*
I understand my credit card will be billed monthly based on my number of locations.
*
Yes
This is a ongoing monthly agreement and can be cancelled at any time with a 30 day notice.
*
Yes
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