Global Calling Card Request

Individual Established corporation Start-Up corporation

Your Name:
First:
 MI:
 Last:
Title:
Organization:
Address 1:
Address 2:
City:
 State/Province:
Postal Code:
 Country:
Home Phone:
 Fax Phone:
Work Phone:
 Extension:
E-mail:
Web address:
How did you hear about us?

PIN ONLY request (standard cards only)

Payment Information:

*This service is post-paid, bills will be sent via e-mail at the end of month.

Payment method:

Credit Cards:

 Name on Card:
Card Number:
 Exp. Date:
Please enter the 3-digit value at the end of the number printed on the back of your card.

Automatic debit authorization: The undersigned authorizes Highway Telecommunications USA to debit the above credit card in payment for services performed in connection with long distance calls generated by the user so designated in this agreement. This service is post-paid. The undersigned also agrees to a charge of 3.5% credit card processing fee if paying by credit card (based on the monthly usage). Highway Telecom reserves the right to refuse service.
 I Accept Type your name:

You will be contacted within 24 hours to confirm your order. 

Thank you!