Print this Form, Send it by Mail or Fax

Send it to us completed, along with your payment for quick service.
We will expedite your order(s) immediately!

Feel free to call us at (888) 227-6135

or

by FAX: (561) 423-9298

Order Form

Name:

Mailing Address::

City:

State / Zip-Postal Code and Country:

Phone Number:

Email:

SS# or Tax ID:

Date:

1. Select the package you are ordering:

Check off your choice below

800 Bill to Credit Card TM

Includes 1 Extension

Package Setup Fee
Live $599
Recorded $599

This is a one-time setup fee with a $50 per month maintenance fee per line. No long term monthly contracts - you may cancel anytime without penalties.

For Multiple Extensions / $60 each additional.

Package Price Extensions Setup Fee
Live $599 + $60 2 $659
Live $599 + $120 3 $719
Live $599 + $180 4 $799
Live $599 + $240 5 $839

This is a one-time setup fee wtih a $70 per month maintenance fee per line. No long term monthly contracts - you may cancel anytime without penalties.

2. Select the Billing Rate:

This is the price you'd like to charge callers.
Circle your choice below.

800 Bill to Credit Card TM

Per Minute Flat Rate
$.99 per minute $10.00 per call
$1.99 per minute $15.00 per call
$2.99 per minute $20.00 per call
$3.99 per minute $25.00 per call
$4.99 per minute $30.00 per call
$5.99 per minute $35.00 per call
$50.00 per call
$75.00 per call

3. Enter the Forwarding numbers:

FOR LIVE PACKAGE ONLY

  • Extension #1 - Forward to this phone number: *Include Fee
  • Extension #2 - Forward to this phone number:
  • Extension #3 - Forward to this phone number:
  • Extension #4 - Forward to this phone number:
  • Extension #5 - Forward to this phone number:

4. Payment Information:

Total Enclosed: $

Payment Method:

  • Money Order
  • Certified / Bank Check
  • Credit Card
  • Personal Check (takes 3-5 additional
    business days to process)

Credit Card / Debit Card Info:

  • Visa
  • Mastercard
  • Discover
  • American Express
  • Full Name:
  • Billing Address:
  • Credit Card / Debit Card Number:
  • Expiration Date:
CVV Number:

(Visa / Mastercard / Discover) The 3-digit number in reverse italicson the back of your credit card. (American Express) The 4-digit number on the front, just above your credit card number.

Please make your check or money order payable to:

FutureQuest Marketing, Inc. Attn: New Accounts 3003 Yamato Road, Suite C8-1063 Boca Raton, FL 33434

Credit Card Orders May be mailed or Faxed to (561) 423-9298
Phone Orders/Questions (888) 227-6135

Signature: Date: