Fill in the following information about you/your business.
Date_____________________
Business Name/Your Name_______________________________________________
Mailing Address______________________________________________________________
City:_____________________________State:_________Zip:__________________
EMail Address: ________________________________________________________
Telephone Number: (______)_____________________________________________
Fax Number: (______)______________________________________________
Please enroll me on the TAT Techline for plan #______(choose 1-5)
Plan 1. Per call $3.50 per minute (*Pay Per Use) *credit card only (suggested plan if usage is unknown)
Plan 2. Twelve month subscription of 400 minutes of service - $1000 ($2.50/minute)
Plan 3. Six month subscription of 206 minutes of service - $550 ($2.67/minute)
Plan 4. Three month subscription of 103 minutes of service - $301 ($2.92/minute)
Plan 5. One month subscription of 34 minutes of service - $100 ($2.94/minute)
If you have any questions or wish to enroll by phone call 1-800-636-6414 or (615) 595-6974 Monday-Friday, 7AM-7PM CST.
American Express/Visa/MC/Discover#: _____________________________________ Secure Card Number ______
Expiration Date: Month____________ Year___________
Billing address if different from mailing address: ______________________________
City _____________________ State ___ Postal Code/Zip ________
Fax form to: (615)-595-6903.