IDT LogoIDT TravelTel & callback Order Form
New Customer (13) C1
Order Form
Required: Copy of Passport & front/back of credit card being used must be faxed in with this page for your order to be processed.
Rep ID#   2688            Rep Name:  Association of Independent Telecom Managers
Fax To:   425-702-8758        Email: admin@mast-ent.com Date:         /    /       

Billing Information (Please print)
First Name ___________________________ Last Name ______________________________________________
Street Address_____________________________________________
City _______________________ Postal Code__________ State/Country___________________________
Preferred Contact Method:
o Fax # _________________________ o E Mail _________________________________

CallBack Service Great from your home, office, cellular & car phone
CallBack Numbers (Include country and city codes of Non-US phone numbers where customer will receive the CallBack)

011-                                                                        011-                                                       
011-                                                                        011-                                                       
o IDT should send customer "Welcome Letter" (Rep mark here) Attach additional CallBack Numbers as needed

Phone Card Great for customers on the move - either in your country or around the world

Initial Dollar Increment & Recharge Amount: o $25 o $100 o $250 (Select one only)

14 Digit PIN # (Keep your PIN confidential) ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___

For this service only, your Credit Card will initially be charged by the amount you select above. Every time your TravelTel Phone Card balance falls below $10, your credit card will be automatically recharged for the amount selected above plus the balance needed to restore your $10 minimum threshold. You will not be interrupted in the middle of a call.

Credit Card Information (Please print) If choosing to pay by Bank Wire or cash deposit, simply write words below. 
Be sure to review the Billing Requirements for this option. (Someone will contact you)

Cardholder Name (As it appears on the card) __________________________________________________

Exp. Date ________/________ Card Type:       American Express o        Mastercard o         Visa o

Card Number _____________________________________________________________________
Credit Card Address (Where customer receives credit card statements):
o Same as Above o Other ____________________________________________________
Cardholder’s Signature X                                                         

The Signatory Hereby:
 Authorizes IDT and their underlying carrier to take all steps necessary to provide telecommunication services to the signatory. Agrees to pay all charges related to these services in immediately available U.S. funds charged to the signatory’s American Express, Mastercard or Visa. This authorization shall remain in effect until IDT receives written notification to cancel this authorization. Customer agrees to pay all charges related to these services, including but not limited to the use or misuse by an unauthorized third party, or any error, accidental use or loss. IDT specifically disclaims any liability, loss or risk which is incurred as a consequence, directly or indirectly, of the use of the TravelTel Phone Card or the Travel Companion Callback Number. The signatory agrees to indemnify IDT, and hold IDT harmless from any loss, damage or expense (including reasonable attorney fees) that IDT may suffer as a result of the breach by the signatory of the foregoing agreement, or as a result of the collection efforts that IDT may reasonably incur by reason of any said breach.