LONG
DISTANCE

COUNTRY
CODES

BROADBAND
(VOIP)

IPTV

INTERNET
SERVICES


Kantor Ltd.

Customer Service:
Tel: 416-628-5199
Toll free: 1-877-848-6376

1) Customer Information

Please type your name as it appears on yours residential telephone bill.

	Last Name: *
	First Name: *
	E-mail address *
	Home Phone No. *
	Work Phone No. *
	Home Address: *
	City: *
	State: *
	Zip Code: *
	Drivers License Number:		or
	S.S.N. #		or
	Passport:
	Country *
	Date of birth *

2) Phone Number Registration

Please list the USA phone numbers you wish to register. You must have Authorization to register these numbers.

	Phone 1 *
	Phone 2 *
	Phone 3 *

Agreement & equal access authorization.

I authorize Kantor Ltd. to make credit inquiries at any time in connection with the credit hereby applied for. I agree that the terms for using Kantor Ltd. services & amendments thereof as Kantor Ltd. may stipulate from time to time will apply to me on acceptance of application. I acknowledge that accounts are due within 21 days from invoice date & will be subject to a late payment charge of 3% per month. By signing, I agree to subscribe the above telephone numbers to Kantor Ltd long distance service, the charges for the call will be billed by Kantor Ltd & passed through Kantor Ltd network or any network of Kantor Ltd choice. I have listed all phone numbers above that will be operated in this manner. I understand this authorization may be faxed, with the same force & effect as an original authorization.

License Agreement. I have read and agree to the terms & conditions of the above license agreement


	Signature of Applicant		Date
	(Please Type in your name)

Security code
(enter only digits in the frame)*: