Name: ________________________________________________________________________________

                       (First  Name)                                                            ( Last Name)


Company Name: ________________________________________________________________________


Address: _______________________________________________________________________________


Phone#: ______________________________________        Fax#: ________________________________


As part of this agreement, ”Customer”/Cardholder authorizes VoiceGate Corporation to charge for said product and / or
service on the credit card information indicated below:

 Credit Card: (Please Circle)                 Visa                           MasterCard                              American Express


Credit Card Number: ___________________________________________    Expiry Date: _____________


Cardholder Name: _______________________________________________________________________


I,________________________, have been  authorized to make purchases for “Customer” and am an authorized signatory on  this credit “card”.

         (Authorized Signature)

This “Card” authorization will apply and be legally binding for any future orders (written or verbal) placed by “Customer” via phone, fax, e-mail, or any other means.  In addition to the card signatory, the following individuals may place orders on “Customer’s behalf”:

_____________________                       ______________________                      _____________________
           (Name)                                                        (Name)                                                      (Name)

_____________________                       ______________________                      _____________________
         (Signature)                                                   (Signature)                                                (Signature)

and I understand all charges will be applied to the aforementioned credit card.

Should “Customer” choose to revoke such “Card” authorization, he/she must do so in writing, with said revocation
taking place within ten business days of receipt of said notification.

Written notification is to be sent to:
VoiceGate Corporation, 10520 Yonge Street, Unit 35B, Suite 233, Richmond Hill, Ontario  L4C 3C7

Signature:__________________________________________               Date: ________________________

 To send a fax mail dial: 905-508-0355, enter “*2165”, wait for the tone and  then press the start key on your fax machine or; scan and email to lcartier@voicegatecorp.com..  A VoiceGate technician will contact you to set up a call-back time once your information has been processed.Thank you for your patronage.  VoiceGate is committed to providing the highest quality service available in the international market place.
Prepaid technical support hours are from Monday to Friday 9am – 5pm EST.  Unused Pre-paid support is valid for 6 months from the date the credit card was processed.