2) Street Address:

3) City:

4) State: Alabama Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington, D.C. West Virginia Wisconsin Wyoming xxx 5) Zip Code:

6) Name:

7) Email Address:

8) Telephone Number:

9) Fax Number:

10) How will you be using your custom phone cards?

11) How many cards are you considering? Select One 25 50 100 250 500 1,000 2,500 5,000 10,000 25,000 50,000 100,000 500,000

12) If none of the above quantities are apply, enter your specific quantity here:

13) How many minutes per card are you considering? Select One 5-Minutes 10-Minutes 15-Minutes 30-Minutes 60-Minutes 100-Minutes 500-Minutes

14) Do you want to have a custom greeting, heard each time someone uses your phone cards (must be 8 seconds or less)? Select One Yes No