Order your 0870 number using this form, It will be submitted by e-mail and you'll have a confirmation sent to you. This form is on a secure page although your details are only as safe as the rest of the Internet whilst they are transmitted to us. For a totally secure order please use Fax or post.
  VERY IMPORTANT: Please do NOT apply for a number if you do not intend to use it - admin fee's may become payable by you. Please read the Terms and Conditions page BEFORE you place an order!

Please read the sections carefully before completing, you must complete all sections marked *
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Your Name: * (who to make cheques payable to)
Company Name:    
Pay cheques to: * (A Valid bank account name)
Connect To: * (the number to transfer 0870 calls to)
2nd Destination:   (only where follow-through is requested)

** NOT available for mobile or non-geographical numbers, UK fixed lines only please
** Offer not available outside the UK (country code 44) or to the Channel Isles, Sorry
E-Mail Address: * (to confirm the order)
Postal Address:
Including Postcode		 * (to send cheques to)
Contact Tel. No.: * LANDLINE only please
Fax No.:   (may be left blank)
Any comments ?:   (may be left blank)
Acceptance of terms: * (type I AGREE) (order will be rejected without this)
-You are signing an contract which is enforceable by law by typing I AGREE. This implies that you have read and understood the terms and conditions
plus other details applicable to your order, that you are over 18 years of age and that you will make use of the service(s) provided or pay the applicable charges.

The cost of this order is £0.00, ie free of charge, and there is no delivery cost.

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FIELDS MARKED WITH * ARE REQUIRED!
Please note that incomplete submissions will not be processed. This information will not be passed on to other organisations other than to set up the account.
Thanks to Graeme at http://www.cutandpastescripts.com for help with this form. His site has loads of similar scripts for use on YOUR site ?

Last updated May 30th 2001