First Name *
Last Name *
Company Name (If Applicable)
Contact Telephone No. *
Address *
Apt/Unit
City *
Prov/State/Region *
Zip/Postal *
E-mail Address: * Country * Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua & Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahama Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Iislands Costa Rica Cote D'ivoire (Ivory Coast) Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard & McDonald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iraq Ireland Islamic Republic of Iran Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea, Democratic People's Republic of Korea, Republic of Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macau Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova, Republic of Monaco Mongolia Monserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Lucia Samoa San Marino Sao Tome & Principe Saudi Arabia Senegal Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands Spain Sri Lanka St. Helena St. Kitts and Nevis St. Pierre & Miquelon St. Vincent & the Grenadines Sudan Suriname Svalbard & Jan Mayen Islands Swaziland Sweden Switzerland Syrian Arab Republic Taiwan, Province of China Tajikistan Tanzania, United Republic of Thailand Togo Tokelau Tonga Trinidad & Tobago Tunisia Turkey Turkmenistan Turks & Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom (Great Britain) United States Minor Outlying Islands United States of America United States Virgin Islands Uruguay Uzbekistan Vanuatu Vatican City State Venezuela Vietnam Wallis & Futuna Islands Western Sahara Yemen Yugoslavia Zaire Zambia Zimbabwe
Order USA DID (City + State)
Order USA DID (City + State)
Order CANADA DID (City + Province)
Order CANADA DID (City + Province)
Order TOLL-FREE US/CAN DID(s) Not Applicable Order 1 Order 2 Order 3
Order 911 Service for US/CAN DID(s) No, I decline 911 service at this time Yes, activate 911 service on 1 DID Yes, activate 911 service on 2 DIDs Yes, activate 911 service on 3 DIDs Yes, activate 911 service on 4 DIDs
Address(es) For 911 Service (Specify DIDs))
Existing US/CAN DID to Port ($29)
Existing US/CAN DID to Port ($29)
Enable Voicemail On DID(s) No Yes
Enable International Calling No Yes
International Calling Routes Level 1 (Economy) Level 2 (Premium)
Device Type Being Used ATA / IP Phone / Softphone IP PBX / Asterisk / Softswitch
Connection Protocol SIP
Connection Codec G.711u G.729a Gsm Allow All (G.711u,G.729a,Gsm)
DTMF Mode AUTO RCF2833 (AVT) INBAND INFO
NAT (Behind Router With NAT) No Yes
Low Balance Notification Level $10 $20 $30 $40 $50 $60 $70 $80 $90 $100
Low Balance Email Address
Additional Comments/Questions
* Required