netYAK Service Order Form

A red asterisk (*) indicates that the field is required.

Billing Information:

*Name:

*Company:

*Address:

*City:

*State:

*Zip Code:

*Country:

*Phone Number:

- -

*Fax Number:

- -

*E-mail Address:

*Website URL:

(your netYAK Account Number will be sent to this e-mail)

(for example, www.netyak.com or netyak.com)

Technical Contact (if different from above):

Name:
Address:
City:		State:
Zip Code:		Country:
Phone Number:	- -	Fax Number:	- -
E-mail Address:

Calling Plan Prices:

Plan: (per month)	Included Minutes:	Activation Fee:	Call Reports: more info	Detail Reports: more info
A - $19.95	100		No Reports	No Reports
B - $39.95	200			$5.00
C - $59.95	300			$5.00
D - $99.95	500			$5.00
E - $129.95	700			$5.00
F - $184.95	1,000			$5.00

Yes! Please include Detail Reports for this plan for $5.00 per month.

Service Requirements:

Phone number to receive calls, area code first:
more info

*1. - -

Your first phone number is included. Please indicate below if you would like to netYAK-enable 1 or 2 additional phone numbers for $9.95 per number per month:

Number of Additional Phone Numbers:

*2.

Second phone number to receive calls:	*2. - -
Third phone number to receive calls:	*3. - -

I would like to netYAK-enable more than 3 phone numbers - please contact me.

Order Total:

Calling Plan:

Activation Fee (waived!):

Standard Reports (waived!):

Detail Reports (optional):

Additional Phone Number Charge (optional):

Order Total:

*By clicking the "Submit" button, I agree to the netYAK Terms and Conditions

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