Company registration number 199201624D
31 Exeter Road, #21-00 Comcentre, Singapore 239732
Tel: 1800 532 1188 or +(65) 6532 1188
Fax: +(65) 6533 2872
Email:
Service Request-Cum-Agreement for WorldConference Service
Notes: 1. Applications made on behalf of a firm/company must be made by the firm’s/company’s duly authorised officer.2. Please state “NA” where inapplicable.
Section A: Particulars of Applicant
Name of Firm/Company: / Certificate of Incorporation/Unique Entity No:
Correspondence Address:
Type of Business:
Name Of Authorised Officer of Applicant: / Designation: / *NRIC/Passport No:
Section B: For clarification on this application, SingTel should contact:
Name:
Tel/Mobile:
Email Address:
Section C: Fees and Charges+
The Fees and Charges shall be in accordance with (please tick, as applicable):#
SingTel quotation No Item:
Other (please specify):
Notes:
1. If none of the above options are selected and completed then, subject tothe Specific Terms and Conditions,the Fees and Charges shall be at SingTel's prevailing rates as at the time the Fees and Charges are incurred.
2. Any SingTel quotation referred to above muststill bevalid as at the date this application is received by SingTel.
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Section D : WorldConference (WeTalk, WeShare, WeMeet)Moderator/Host #1
a) WorldConference WeTalk and WeShare
b) WorldConference WeTalk and WeMeet 12 months 24 months
bi) Provision to exising WeTalk WebLogin. Please indicate: / Date of Service Required:#
/ / (dd/mm/yyyy)
Moderator/Host
First Name : / Last Name (surname) : / Contact No:
Email Address: / Business Title: / Remarks:
New Account:
Billing Address (if different from correspondence address): / Charge to Existing Account No:
with the following charge number :
WorldConference
Existing: / Request for new no.
DEL / Mobile:
Billing Currency: / Singapore Dollar / ICC (10-digit card no.):
Billing Frequency: / Monthly
Moderator/Host #2
a) WorldConference WeTalk and WeShare
b) WorldConference WeTalk and WeMeet 12 months 24 months
bi) Provision to exising WeTalk WebLogin. Please indicate:
/ Date of Service Required:#
/ / (dd/mm/yyyy)
Moderator/Host
First Name : / Last Name (surname) : / Contact No:
Email Address: / Business Title: / Remarks:
New Account:
Billing Address (if different from correspondence address): / Charge to Existing Account No:
with the following charge number :
WorldConference
Existing: / Request for new no.
DEL / Mobile:
Billing Currency: / Singapore Dollar / ICC (10-digit card no.):
Billing Frequency: / Monthly
------Please duplicate this page for application of more than two (2) moderators/hosts ------
Section E: WorldConference Event ServiceEvent Organiser Contact Name: / Contact No: / Email Address:
Conference Title: / Date of Event #:
/ / (dd/mm/yyyy)
Start Time: / Time Zone: / Expected Duration: / Expected No. of Participants:
Moderator/Host (s)
First Name: / Last Name (surname): / Email Address(s):
Direct Phone No(s):
Management Services Required :
Toll-Free/Local Access numbers
Dial-Out^ (Please attach list separately)
Q & A Session
Rehearsal Call
Roll Call^. Please select:
Participant Name
Company
Country
(^Attendance list will be provided at the end of conference) / Web Service:
WeShare
WeMeet
Not Required
Audio Recording and Playback:
FTP Link of Recording
DVD copy of Recording
Playback via Phone
Remarks (if any):
Section F: VAS Selections
Meet-Me-Secure Set-up (per Moderator)
Meet-Me-Secure Monthly Subscription
Crisis Conference Set-up (first 10 Moderators)
Crisis Conference Set-up (subsequent 5 Moderators)
Crisis Conference Monthly Subscription
Customized Greetings/Branding
Professional Services Monthly Subsription
Remarks (if any):
Section G: Undertaking
*I/We agree to subscribe for SingTel WorldConference Service on the following terms and conditions, which terms and conditions shall apply on SingTel’s acceptance of this application:
(a) SingTel's General Terms and Conditions of Service; and
(b) SingTel’s Specific Terms & Conditions for WorldConference Service ; and”
(c) SingTel’s Billing Terms and Conditions; and
(d) Adobe Connect EULA (WorldConference WeMeet); and
including any amendments SingTel may make from time to time to those terms and conditions.
*I/we acknowledge that *I/we have read and understood the above terms and conditions, and that the terms and conditions may be viewed at http://www.singtel.com or are available from SingTel on written request.
*I/We agree that SingTel shall be entitled to use or disclose any information or data disclosed by *me/us in accordance with Clause 15 of the General Terms, and understand *I/we may withdraw such consent in the procedure as prescribed by SingTel from time to time.
*I/We confirm that all information given by *me/us in connection with this application is true and correct.
Signed for and on behalf of the Applicant by its Authorised Officer:
Signature of Authorised Officer / Date (dd/mm/yyyy) / *Firm/Company Stamp (if applicable)
For Official Use Only:
1. Customer order date: / 5. Faxed on:
2. Document Checklist: / 6. Verified by:
3. BRN: / 7. Name:
4. Date: / 8. Signature
9. Name of Account Manager (as given in Outlook):
10. Email Address of Account Manager:
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*Delete whichever is inapplicable +Please ‘X’ the appropriate box #Subject to resource availability and confirmation by SingTel Version: 06/2012