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CREWCONNECT PACKAGE FORM

Please fill in this form in capitals and send it to Xantic Customer Services
Fax Australia +61 7 5498 0098
Please make sure you are registered as a ChatCard-user with your Xantic sales manager
Former Station12 and Spectec
1. Customer details / Delivery address CrewConnect Package
Name: / Delivery Address:
Town/City: / State/Province:
Post-/zip code: / Country:
Telephone: Country code> <Area code> <Subscriber number> / Contact person:
Fax: Country code> <Area code> <Subscriber number> / Sales manager Xantic:
E-mail address:
V.A.T. number (EU Companies only):
Xantic account number:
2. CrewConnect Request
I want to order 30 - 500 unit ChatCards & 1 CrewConnect CD-rom (you can proceed to box 4)
3. CrewConnect Request for ISP’s only

I have already bought 30 - 500 unit ChatCards and want to use these for the CrewConnect Package: the numbers of the cards are listed below. These cards are not part of any other package deal and these cards are not activated yet.

Yes, please activate these cards for me Yes, I would like to have 1 Crew Connect CD-rom

500 unit ChatCard serial numbers

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500 unit ChatCard serial numbers

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500 unit ChatCard serial numbers

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The serial numbers can be found on the reverse side of the ChatCard, in the lower left corner
4. Mini-C & Vessel Details
Mini-C ISN: / Mini-C MES ID NR /IMN: *
4 / T / T / 4
Vessel name: / Type of vessel: (e.g. tanker)
IMO nr: / Country of vessel registration:
Gross Tonnage: / MMSI: / Call Sign:
* If a mini-C activation form is attached to this form, this field does not have to be filled in: All other fields are MANDATORY
5. Agreement
Name & Date: / Signature:
Xantic will guarantee, under normal circumstances, that the cards will be sent within 1 week. Payment terms are 60 days after ordering of ChatCards. The administration and sending fees will be charged to the purchaser. For more information go to www.xantic.net or contact Xantic Customer Services: + 61 7 5498 0000 BK-09-02