Fast_Ring_Order_Form

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 *

Number of Stores or Locations *

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 *

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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