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Put Callback into Your Web Here!

Fill out this form for your personalized web callback service!
Terms and conditions appear below

 

You and Your Organization

Your Name

Referred By

Organization

Title

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Work Phone

Fax

E-mail

 

Credit Card Details

Credit Card #

Expiry Date (mmyy)

Name on Card

Card Issuer

 

Callback Site Details

 

This message will be displayed on the call form that prompts the customer for their phone number

Message for Call Form

 

Please enter the international code and telephone number to receive WebCallback calls (e.g. USA is 1, France is 33, etc.)

Callback Country Code

Callback Phone Number

 

Fill in the following field if your call center can handle multiple simultaneous calls

Number of calls

 

Enter the URL of the site which you wish to use the WebCallback service from (e.g. www.xyz.com)

Web Site URL

Login

Password

 

You may restrict calls so they only come from a single country. For example, to restrict calls to within the USA, enter country code 1.

Restrict International Calls?

Yes No

Allow Only Country Code

 

Office Hours (Optional)

 

Note - you may skip this section and create your web page immediately.

 

WebCallback works 24 hours per day. If you don't have voicemail or an answering service when your offices are closed, you may send calls to an alternative number, take an e-mail message, or sign up for GlobalPhone voicemail. If you want one of these options, select YES below, then enter your opening and closing times. These 24-hour times must be in Eastern Time.

Modified Service Outside Office Hours?

Yes No

EST Opening Time

EST Closing Time

 

Using 1 for Sunday through 7 for Saturday list any days your offices are closed so your web site should not call people (example -- Saturday and Sunday would be "17" or "71")

Days Closed

 

Finally EITHER give an alternative telephone number OR an electronic mail address OR select GlobalPhone voicemail service

Alternative Number

Alternative Email

GlobalPhone Voicemail

Yes No

Terms and Conditions

Charges:13.8 cents per minute for continental US calls. GlobalPhone retail rates apply for calls and to Hawaii, Alaska, Puerto Rico and international destinations. $10 per month minimum usage per company applies. $100.00 Set-up fee. To see international rates, click here.

Methods of Payment

Credit Card. Charges will be billed to customer credit card once each month. No deposit required.

Purchase Order. Customer agrees to pay by check within 30 days of receipt of invoice and to maintain a deposit equal to one month's usage. A $100 minimum deposit is required and must be sent with application. Deposits will be returned upon cancellation of service.

Agreement:

Customer agrees to pay GlobalPhone Corp. each month for long distance telephone services by credit card or by check upon presentation of invoice. GlobalPhone will mail a statement that lists all calls and charges at the end of each month. Customer authorizes GlobalPhone to perform a credit check and agrees to pay all outstanding balances owed to GlobalPhone, including any collection expenses incurred by GlobalPhone. I authorize Globalphone Corp. to charge my credit card in the amount of $100.00 for the set-up fee associated with my GlobalPhone WebCallback Account. Service may be cancelled upon 30 days written notice. Disputes must be made in writing, via mail, email or fax no later than 30 days after receipt of invoice.


Signature __________________________________
Date __________________________________

 

 
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