INTERCOMMUNICATION AMERICAN SYSTEMS , Inc.
Application Form.
BILLING INFORMATION MAILING INFORMATION 
(if different from billing address)
Subscriber´s Name or Company Name Subscriber´s Name or Company Name  
Street Address   Street Address  
Street Address (line 2 if applicable)   Street Address (line 2 if applicable)  
City / Postal code / Country   City / Postal code / Country  
Telephone Number  /  Fax Number   Telephone Number  /  Fax Number  
Primary Contact Name & Title   Primary Contact Name & Title  
IAS, Intercommunication American System, Inc. Agrees to provide and the Subscriber (named above) agrees to pay for all services rendered by IAS.
The Subscriber further agrees to use the IAS  services  in  accordance  with  the  instructions  provided and by  signing below,  acknowledged that
he / she has read, understands and agrees to the terms of this contract.
IAS SERVICE TYPE INVOICE NUMBER AMOUNT
     
     
     
AUTHORIZATION
Please read this carefully: I (we) do hereby authorize IAS , Intercommunication American System , Inc. To charge my credit card / bank account 
listed  below  in  the  amount  listed  above . I (we) shall be  responsible  for  all outstanding charges. Charges will be made in the name of IAS, Inc.
I (we) hereby authorize IAS to conduct a credit history check should they deem necessary.
AUTOMATIC BANK PAYMENTS  AUTOMATIC CREDIT  CARD PAYMENTS
Signature of Bank Account Holder                                     Date : Type of Credit Card  
Name of Bank  :                                          Bank Route # : Signature of Cardholder :                                                   Date :
City / Province / Country of Bank :   Name of Cardholder :  
Bank Account Number   Credit Card Number :                                               Exp. Date :
* Attach voided check & photo ID   * Attach copy of front & back of card and photo ID
** This agreement must be signed by the subscriber and original sent to IAS at the address below **
Drivers License or passport Number :   Date of Birth :   ( month / day / year )  
Customer Name :   Company :                            Title  
Signature of Customer :   Date Signed :  
1935 Hollywood Boulevard . Hollywood . Florida 33020  USA
telephone : 952 922 4088 . Fax 954 922 3072 . Email: info@ucall.net . Website: www.ucall.net