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SERVICE REQUESTING:

ACCOUNT NUMBER:

YOUR GTIGLOBAL Account eMail:

SELECT NEW DATA PLAN:

MOBILE FEATURE:

SELECT CALL PLAN:

SELECT DID OPTIONS:

DID AREA CODE:

PBX IP/DOMAIN (type NONE if none):

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SIM NUMBER:

DID NUMBER:

DATE REQUESTED:

PAYMENT OPTION:

GTI-DID Purchase Note (confirm read):

SEND NOTE WITH YOUR REQUEST:

I/We Accept Terms Of Service:

http://www.gtiglobalus.com/customer_services_agreement.htm

VERIFIY & SIGN ORDER FORM:

By signing below and submitting this ticket/order, I hereby acknowledge, affirm, and expressly agree that I have read, understand, and am legally bound by the Terms of Service. I further acknowledge that all new orders are **non‑cancelable** and require **full payment in advance** prior to the activation or provisioning of any services. I understand and agree that all sales, including but not limited to the activation of any SIM associated with Mobile Wireless service, are **final**, **non‑refundable**, and **irrevocable** once activation has occurred. I waive any right to dispute, reverse, or otherwise challenge charges related to such activation, except where prohibited by applicable law. I further acknowledge that submission of this ticket/order constitutes my voluntary acceptance of these terms and serves as my binding authorization for GTIGLOBAL to process payment and activate the requested services in accordance with GTIGLOBAL Agreement.

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