Pro Plan Residential Service Agreement PLATINUM COMMUNICATIONS CORPORATION #280, 550-71 Avenue SE Calgary, AB T2H 0S6 COMMUNICATIONS Toll Free: 1-866-301-4590 Toll Free Fax: (866) 876-5351 Email: [email protected] Broadband. Everywhere. Page | 1.0 Pro plan Residential service agreement Full Name: Primary Phone: Mailing Address: Second Phone: Company Name: (If Selecting Small Business Plan) Business Phone: City / Town: Postal Code: Legal Land Description (Quarter, TWP, RG, Meridian) Or gps Coordinates Email Address: (Required For E-billing) Rural Address: (911 Address) Customer Information Driving Instructions: (Where To Locate You In An Emergency) E.X. 999 Range Road, Red Deer t2y 1k8 Monthly No Contract Select Your Plan Pro $59.95 Basic Residential Internet - Unlimited Data Transfers Pro + Phone Pro + Unlimited Phone +$29.95 Residential Internet with Unlimited LD Digital Phone Bundle Light $49.95 Basic Residential Internet - Unlimited Data Transfers 900Mhz - Lighter speeds - Perfect for treed areas Sub Total (Service Plan + Hosting + Install Free) G.S.T. 5% $39.95 Residential Service Agreement Install Fee Options (Pick One That Suits You) 2 Year Contract (I want my install for free!) $49.95 +$20.00 Residential Internet with Digital Phone Bundle No Contract (I want to save $100.00 on my install!) Monthly 2 Year Term $ 299.95 $ 199.95 $ 299.95 ALL OF THE “TERMS AND CONDITIONS” are ON WWW.PLATINUM.CA AND HEREIN FORM THE ENTIRE AGREEMENT BETWEEN PLATINUM COMMUNICATIONS AND THE CUSTOMER. I HAVE READ AND AGREE TO THE TERMS AND CONDITIONS ON AND HEREIN WISH TO CONTRACT WITH PLATINUM COMMUNICATIONS TO PROVIDE SERVICE. VOIP PHONE EMERGENCY 9-1-1 FEATURES DIFFER FROM TRADITIONAL 9-1-1 SERVICES. VISIT www.platinum.ca/ voip-terms-and-conditions FOR MORE INFORMATION. TOTAL Signature: ______________________________________ date: Send My Invoice via Email ______________________________________ Send My Invoice via Canada Post ($2.50/ Per Mail Out) Pro plan Credit Card/ Pre-authorized debiT bill payment PLATINUM COMMUNICATIONS CORPORATION #280, 550-71 Avenue SE Calgary, AB T2H 0S6 COMMUNICATIONS Toll Free: 1-866-301-4590 Toll Free Fax: (866) 876-5351 Email: [email protected] Broadband. Everywhere. Page | 2.0 Pro plan credit card bill/Pre-authorized debit (PAD) payment Credit Card PAYMENT Credit Card Type (I hereby authorize Platinum Communications Corp. to automatically bill the card listed above for any installation, activation, service call, termination, and monthly recurring charges). Credit Card Number Signature: ______________________________________ Credit Card Holder Name date: ______________________________________ Expiry Date S Pre-Authorized Debit (pad) PAYMENT - (Additional Legal on Page 5) Please attach VOID cheque Customer / Business Name I/We (the above named Customer(s)) authorize Platinum Communications Corporation to debit my/our personal/business (circle one) account at the “Bank” as given, in the amount of $_______________ on the First (1st), or the Fifteenth (15th) (circle one) day of each month payable to the Company in respect of: Internet access fees and taxes as applicable. Each payment shall be the same as if I/we had personally issued a cheque authorizing the Bank to pay Platinum Communications Corporation as indicated and to debit the amount specified to my/our account. I/we agree to reimburse the company for bank charges resulting from insufficient funds in the account. I/we agree to bank charges, interest or other fees resulting from insufficient funds in the account being added to the monthly debit. As the payment amount may be variable I /we waive any requirement that the Company give pre-notification of any payment amount. The Payor (biller) and Payee (Platinum) may mutually agree to reduce or waive the pre-notification requirement. I/We will provide 45 days notice in writing to the Company if I/we close this account if I/we are unable to provide the Company with 45 days written notice, I/we agree to reimburse the Company for bank charges resulting from insufficient funds in the account. I/We understand that the Bank is not responsible to verify whether these payments are properly debited to my/our account. This authorization may be cancelled at any time upon written notice by me/us to the Company. I/We understand that if I/we cancel this authorization, it does not mean that my/our contract obligations to the Company are ended. Any delivery of this authorization to the Company constitutes delivery by me/us to the Bank. I/We, have certain recourse rights if any debit does not comply with this agreement. For example, I/we have the right to receive reimbursement for any debit that is not authorized or is not consistent with this PAD Agreement. To obtain more information on my/our recourse rights, I/we may contact my/ our financial institution or visit www.cdnpay.ca. I/We am/are the only authorized signature(s) on the above given account. Signature: ______________________________________ date: Signature: ______________________________________ ______________________________________ date: *REMEMBER* ATTACH VOID CHEQUE TO THIS PAGE www.platinum.ca ______________________________________