Online Service Application

Thank you for choosing AccuDial. Please fill out the form below...

Customer Information

Please enter the customer information below:

Business Name:	(If business account)
Contact Name:	(first, last)
Address:
Suite/Apt #:
City:
State:
Zip
Contact Phone:
Contact Fax:
Email:

ACCOUNT INFORMATION

User name on each card:	Phone number No area code*	Monthly Credit Limit	QuickLinQ Phone Numbers (With Area Code)

*Enter only 7-digit phone number without the area code! This will be used as first 7 digits of your pin number.

PAYMENT OPTIONS:

I authorize payment to LINQ for my bill every month using the credit card listed below. Monthly statements will be delivered to me via a secure web server. No statements will be mailed. $1 Monthly billing fee will be charged any month there is usage of the account. No fee in months with no usage. There is a $1 activation fee.

IMPORTANT NOTE FOR BUSINESS APPLICATIONS

If this credit information is acceptable, my company promises to make prompt monthly payments of any billing as required maintaining this credit status, and agree to a monthly minimum of $50 starting on the first full billing cycle. $2 monthly billing fee for approved Corporations. The credit card information entered on this form will be for verification purposes only, and will not be billed for service if account remains in good standing. There is a $1 activation fee per PIN up to a maximum of $5.

NOTES:

Cardholder agrees to 1) Be liable for all charges to the billing card number issued on this account. 2) Authorize credit card payment if account is past due. 3) Pay a late fee if payment is not made by the due date on the unpaid balance, at a rate of 1.5% per month. 4) Hold LINQ and its agents harmless from incidental and consequential damages. Cardholder represents that he/she has the authority to order this service. LINQ assumes no liability for calls not completed due to circumstances beyond its control. LINQ makes no warranties expressed or implied, except as stated in this agreement. Cardholder's Credit Card will be debited by LINQ. Cardholder accepts the terms and conditions imposed by LINQ for the use of its service and agrees that a secure website submission is binding. *FCC mandated payphone access fee (30 ¢) could apply to calls originating from a payphone.

Your IP address will be recorded (38.107.191.96). In the event of suspected credit card fraud, Police agencies and your local phone company will cooperate to determine the phone number from which your call originated.

Credit Card Information

Credit Card Type:
Credit Card Number:
Expiration Date
Note: Your credit card billing address must match the service billing address.

CV Number (What is this)?: