Corporate Telecom Solutions

Trial Voice DA New Customer Start Up
Customer Name:		Contact Name:
Billing Address 1:		Phone #:
Billing Address 2:		Fax #:
City/State/Zip:		Email:
Billing Rate:	*whatever is less	# of Locations:
Terms:		Bill to One Location:	Yes No
Billing (A/P) Contact Name:		Billing (A/P) Phone #:
Billing (A/P) Email Address:		Billing (A/P) Fax #:
Estimated Monthly Call Volume: (if known)		Bill to Multiple Locations:	Yes No
Purchase Order #:		Switch Type:
Sales Rep:		"8xx" Number Assigned: (to be provided by Corporate Telecom Solutions)
Does Accounting need a copy of our W-9?	Yes No	Are you tax exempt?	Yes No
		If so, please provide a Tax ID# and certificate:

Please provide the following information for each service location:

ADDRESS - LOCATION 1		ANI(S) - LOCATION 1
CONTACT NAME AND PHONE #		EMAIL ADDRESS


ADDRESS - LOCATION 2		ANI(S) - LOCATION 2
CONTACT NAME AND PHONE #		EMAIL ADDRESS


ADDRESS - LOCATION 3		ANI(S) - LOCATION 3
CONTACT NAME AND PHONE #		EMAIL ADDRESS


ADDRESS - LOCATION 4		ANI(S) - LOCATION 4
CONTACT NAME AND PHONE #		EMAIL ADDRESS


ADDRESS - LOCATION 5		ANI(S) - LOCATION 5
CONTACT NAME AND PHONE #		EMAIL ADDRESS


ADDRESS - LOCATION 6		ANI(S) - LOCATION 6
CONTACT NAME AND PHONE #		EMAIL ADDRESS


ADDRESS - LOCATION 7		ANI(S) - LOCATION 7
CONTACT NAME AND PHONE #		EMAIL ADDRESS


ADDRESS - LOCATION 8		ANI(S) - LOCATION 8
CONTACT NAME AND PHONE #		EMAIL ADDRESS


ADDRESS - LOCATION 9		ANI(S) - LOCATION 9
CONTACT NAME AND PHONE #		EMAIL ADDRESS