AccuLinq The Original 4.9¢ Local & 8.9¢ National Access
Calling Card (No Surcharge* - Billed in 6 Second Increments after the first 30) / Office Use Only
Sales: ______
AUTH #: 0002

ACCOUNT INFORMATION [ ] Check here to add phone and fax number to QuickLinq Service

Account Name / Contact Person
Phone # / ( / ) / Fax # / ( / )
Billing Address / E-mail:
City / State / Zip
CREDIT CARD INFORMATION (Required On All Individual Accounts For Credit Verification Purposes - No Exceptions)
Note: This Section Mus Be Completed Accurately For Application To Be Processed In A Timely Manner
Name That Appears On Credit Card
Billing Address For Credit Card
City / State / Zip
VISA [ ] MASTERCARD [ ] DISCOVER [ ] AMEX [ ] / Credit Card #
NOTE: PAYMENTS WILL BE PROCESSED BY Linq Telecom, Inc.(LINQ) / CC Expiration Date:
PAYMENT OPTIONS (Note: Must Choose Either A, B, or C) Your credit card will be pre-authorized for the total of estimated usage!
You will only be charged the actual monthly usage + tax at the end of the billing period.
[ ] A. I authorize payment to LINQ for my bill every month using the above credit card. No Monthly statement will be issued.
$1 Monthly billing fee. No Fee will be charged if there is zero balance for the month!
[ ] B. I want to authorize LINQ to automatically pay my bill every month using the above credit card & I want a monthly statement issued. $2 Monthly billing fee. No Fee will be charged and no statement will be mailed if there is zero balance for the month!
[ ] C. My company is applying for corporate calling card service and therefore we would like the attached credit information to be
reviewed for credit worthiness. If this credit information is acceptable my company promises to make monthly payments in
accordance with LINQ’s billing terms. $2 Monthly billing fee for approved Corporations.
CARD HOLDER INFORMATION (Allow 72 business hours for activation of cards. Allow approximately 2 weeks for card delivery)
1. Calling card utilizes an 11 digit # for completing calls (phone number + four digit PIN)
2. Please choose a unique 4 digit pin # to apply to each individual card and list accordingly below.
3. This 4 digit pin # will need to be memorized by the card holder since it will not appear on the card itself.
4. A one-time processing and activation fee of $1.00 per card will be charged to your credit card.
LIST MAIN PHONE NUMBER (don’t include area code)
CARD #1 Four Digit PIN / CARD #3 Four Digit PIN
CARD #2 Four Digit PIN / CARD #4 Four Digit PIN
Estimated Monthly Calling Card Usage (Per Card) Phone Numbers to be placed on the QuickLinq Service
[ ] Less then $49.99 / [ ] $50.00 - $99.99 / ( ) ______-______/ ( ) ______-______
[ ] $100.00 - $199.99 / [ ] $200.00 - $299.99 / ( ) ______-______/ ( ) ______-______
Cardholder agrees to 1)be liable for all charges to the billing card number issued on this account. 2)authorize credit card payment if account is pass due. 3) pay a late fee if payment is not made by the due date on the unpaid balance at a rate of 1.5% per month. 4) hold LINQ and its agents harmless from any and damages. Cardholder represents that he/she has the authority to order this service. LINQ assumes no liability for calls not completed due to circumstances beyond its control. Unless prohibited under law, LINQ makes no warranties expressed or implied, except as stated in this agreement. Cardholders Credit Card will be debited by LINQ. Cardholder accepts the terms and conditions imposed by LINQ for the use of its service and agrees that a facsimile signature is binding. Customer authorizes a one-time activation fee of $1.00 per calling card to be charged to listed credit card. *FCC mandated payphone access fee (.30¢) could apply to calls originating from a payphone.
Signature: / Print Name: / Date:
FAX TO: 1-888-622-7616 or 1-309-296-9588
Cognigen Agent ID: af1
Agent Email:
Web Site: http://gbtel.net/linq/ / or Mail To: / Cognigen Corp.
Att: Alexei Flerov
821 E Walnut St # 204
Columbia, MO 65201

AccuLinq …the original 4.9¢ Local &

8.9¢ National Access calling card.

Features

·  8.9¢ A Minute Anywhere In The US (48 States)… Anytime.

·  7.9¢ A Minute from QuickLinQ numbers to Anywhere In The US… Anytime.

·  4.9¢ A Minute Local Access to Anywhere In The US (48 States)… Anytime.

·  QuickLinQ our exclusive feature that allows you to bypass entering your 11 digit PIN when calling from a registered number (ie. Home or Cell Phone number) allowing you to take advantage of our great domestic and international rates.

·  Cities with Local Access numbers: Austin, Dallas, Denver, Fort Worth, San Antonio, and Houston

·  No Carrier Surcharges or Monthly Minimums.

·  Billed in Six-Second Increments after the first Thirty Seconds.

·  Activated within 2 business days of returned application.

·  FCC Mandated Pay Phone Fee - .30¢ fee for each call completed from pay phones utilizing the 800 access (Not Applicable on Local Access).

Usage Procedures

·  Following these steps:

  1. Dial 1-800-846.8413 …listen for tone.
  1. Enter your 11 digit authorization code, followed by "#" key.

Your Code is your phone number plus your 4 digit PIN number.

(Example: 555-7890 and 4 digit PIN number)

  1. Enter 1 + Area Code + Phone Number of the person you are calling.

(International Call: Dial 011 + country code + phone number)

  1. To place another call: Press "*" star key twice.

·  Your plastic cards will be mailed within 10 business days of the returned application.

The Application

Fill in Account Information:

·  Main Account and Billing Information required

Fill in Credit Information:

·  Required on all individual accounts for credit verification purposes

Fill in Payment Options:

·  Must Choose payment option

Fill in Card Holder Information:

·  Fill in Cardholder Name and 4 digit pin # for each card that is requested

Check your estimated monthly usage (per card) and sign the application

Fill Phone Numbers for QuickLinq Service (only available on 800 dial in Access):

·  Fill in Phone numbers you would like to have the QuickLinq Service

·  QuickLinq Service allows you to call our 800 # and bypass having to put in your PIN!

To secure your Calling Card today
fax your completed application to 1-309-296-9588 or 1-888-622-7616
http://www.gbtel.net/linq/


AccuLinQ Customer Name ______

Corporate Card Set Up Customer # ______

Name on Card: User Name for Each Card.

Main Phone Number: Users Main Phone Number without area code (7 digits only).

Four Digit PIN: User Selected 4 digit PIN number to be included after the 7 digit main number.

Estimated Usage: Maximum credit for individual User. Can be selected on an individual basis. Some users might want $50, while some users might need $300 per card because they make international calls.

Name on Card / Main Phone Number / Four Digit PIN / Estimated Usage


AccuLinQ

The Original 4.9¢ Local & 8.9¢ National Access Calling Card

Corporate Credit Application

CORPORATE INFORMATION

Company Name: / Tax ID Number:
Company Address:
City: / State: / Zip:
Phone # / ( ) / Fax # / ( )
Incorporated Name if Different from Above:
Number of Years in Business:
Our Legal Entity is: [ ] Corporation [ ] Partnership [ ] Proprietorship [ ] Other (Explain)
Name(s) of Principal(s):
Title:
Home Address:
City: / State: / Zip:
BANK REFERENCE
Bank Name: / Phone # / ( )
Account Number:
Bank Address:
City: / State: / Zip:
Contact Person: / Title:
TRADE REFERENCES REQUIRED! PLEASE INCLUDE THE LAST TWO MONTHS SUMMARY PAGES FROM YOUR LD BILL!
Company Name:
Home Address:
City: / State: / Zip:
Phone # / ( ) / Account Number:
Company Name:
Home Address:
City: / State: / Zip:
Phone # / ( ) / Account Number:

I hereby authorized Linq Telecom, Inc. (LINQ) to conduct a routine credit check in connection with my application for service. LINQ may use any information obtainable through this credit application of any credit reporting agencies. I understand that such information will be held strictly confidential and will remain LINQ 's property whether or not credit is extended.

Signature (Authorized Officer Only) /
Print Name: /
Date: