Call Tracker Service Application Form

My name is and my email address is .
I would like to use the Call Tracker software. Please create a dataset for my organisation using the information provided below.

Company Name:
Address:
Phone: Fax:

Tell us how many logins you will need

I will require
administrator level login(s), including my own, and
supervisor level login(s). In addition I will need
thousand extra callable numbers per month, over and above the basic 2,500 allowed
logins for users (maximum 100).

Read the following Terms and Conditions


I have read and understood the terms and conditions above and I agree to them.

Choose one of the following three options

1. The company does not wish to access National DNCL data and will use the service only for client, contact and internal DNCL data.
2. The company assumes responsibility for uploading current and complete data from the the National DNCL to the service in a timely manner.
3. The company requests that IBIS take responsibility for downloading current National DNCL data on behalf of the company and to that end grants IBIS authority as a Registered Service Provider to make use of the company's DNCL registration, subscription and download key according to the NDNCL regulations as follows:
Registration Access Number
Subscription
Access Number
Download Key

"Sign" and date the form

An email will be sent to the address at the top of this form. It will contain the pricing for the service you have requested based on our posted prices. You must reply to that email as confirmation. When we have received your reply we will check your subscription(s), set up your account and access codes, and send your password(s) along with your first invoice to your email address. Service will commence at the time of billing and payment will be due 15 days from that date. Your service will continue if payment has reached us on or before the due date. The time between billing and payment amounts to a free trial period for the service.

I am the person first named above. I submit this application and I am authorised to bind the corporation.

Dated this day of in