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Online Application Form

If you would to prefer to print an application form a printer friendly one can be found here

Personal and Business Application Form
Name*
Country*
Address*
Post Code*
Telephone Number* 
 
with international dialling code 
e.g. +44
Mobile Number
Fax Number
Email address*
 

Authorised users

Please enter below the number(s) where you wish to receive a call back, use international direct dial or use PC to Phone

Name Telephone Number (at least one telephone number is required)*
 

Private Information

For security reasons only.  All fields are required.
How Long have you lived at your current address ? * Yrs
Date of Birth *  
First School * 
Nationality *
Mother's Maiden Name* 
 

About the service

 
Where did you hear about us ?  If in a publication please state which one*
Where will you be making calls from and too?
From:*
To:*
Expected Monthly Usage £GBP  US$
  

Declaration

I hereby apply to become a subscriber to the EuroComm Ltd. international service and agree to the terms and conditions as set out on this website. I understand that l will be responsible for the charges for all the EuroComm Ltd. direct dials, SIM or access numbers issued under this account. I accept that as access to my EuroComm Ltd. international service can be made only from my telephone number(s) or by inserting the account number(s) and PIN(s) known solely to me, I accept full responsibility for the payment of all charges for calls using such number(s) and PIN(s) regardless of whether or not such access was authorised by me.
I hereby authorise EuroComm Ltd. to debit all calls using the direct dial, SIM or international call back service on the telephone numbers listed above at the end of each month, to my credit or debit card as designated on this application (if my expected usage is over £200 per month then on a prepaid basis with an automatic top up equal to my monthly expected usage). If my credit or debit card is lost, stolen, cancelled or expires, for any reason, or if  I wish to terminate this authorisation to bill my credit or debit card for any reason, I will immediately notify EuroComm Ltd. and the  credit or debit card company.

Payment

For security reasons we will contact you regarding your payment scheme when we receive your application.

 

To continue you must agree to the above Declaration.  By Clicking Agree you accept the above terms