ICR - Telco Pre-Selection Signup Form

Internet Services :: Telco Pre-Selection Signup Form

Telco Pre-Selection Signup Form

Please complete, Print (Print Friendly), Sign and Fax to ICR on 07-4636-3513

Username	@icr.com.au	Contact Phone
Full Name		Contact Fax
Street Address		Contact Mobile
Locality/Town		P'Code
EXPECTED TIME FOR DELIVERY OF TRANSFER TO ICR IS 14 BUSINESS DAYS All Service Numbers listed will automatically be provisioned for Business Override on ICR's network. ICR will be your preselected carrier for national, international and fixed to mobile calls. Please list the Service Number(s) below or, if additional space is required, please print multiple copies of this sheet. Please list the Service Address for each individual Service Number if it is different from the address provided above.
Phone Number:		Service Address: (if different)
Phone Number:		Service Address: (if different)
Phone Number:		Service Address: (if different)
Minimum Monthly Spend:	$	Minimum Term:	Months
Authority - please tick, print then sign I understand that I am responsible for the charges associated with this telephone account. I accept that invoices raised by ICR for this use are payable upon preparation of the invoice. I understand that by nominating ICR for my Service Number(s) above, International Calls, National Long Distance Calls, and Calls to Australian Mobiles will be carried by ICR after this request has been processed and that, if the Override Code (1423) is used, ICR will also carry my Local Calls. I warrant that I am a representative of the customer authorised to sign this document. I have read, understand and will adhere to the Terms and conditions for use of this service. Signature: Date: ___ / ___ / 200__

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