Long Distance Enrollment Form
Referral
If you were referred to us by another Ucall Long Distance customer,
Please enter their name.
Referrer:  

Authentication Information
Please choose a Username that is hard to guess but easy to remember. Minimum length for username is 4 characters, minimum length for password is 9 characters
User:  
Password:  
Confirm Password:  
Contact Information
Name:  
Company:  
Address:  
City:  
State:  
Country:  
Zip Code:  
Phone Number:  
Fax:  
Email:  
Payment Information
Pay by Credit Card
Credit Card Number:  
Name: (as appears on card)  
CVM Code:  
*CVV2 is a 3-digit value
at the end of your account number
printed on the back of your credit card.

On American Express cards,
CVV2 number consists of 3-4 digits
located on the front of the card. 		International Calling Card
Exp Date:    

Pay by Bank Withdrawal
Bank Name:  
Bank City/Province/Country:  
Bank Account Number:  
Bank Routing Number:  

Pay by Paypal
Service Options
Pay now, Talk Later     Purchase Amount: $ 
Talk now, Pay Later Purchase Limit: $ 


Originating
Telephone Numbers:
 
Choose a service

Destinations Telephone
Numbers(When applies)


(Place each number
on a separate line)

example:
9548675309
3058675309
 
Submit Order