FAX & Tel: (919) 383-6384 Leon Lee Telecommunications Customer #:___________
or send to 1315 Morreene Rd. #24k, Durham NC 27705

(Please TYPE or PRINT)
Contact Name:______________________________

Billing Address:____________________________________________ (No PO BOX, please)

____________________________________________________________

Contact Phone:(_______)_______________ FAX (________) _____________________

E-mail:_____________________________________________________

Choose your 7 digits access number: ___ ___ ___ ___ ___ ___ ___

Charge to your credit card

Payment:

Credit card information:

Type of creidt card: ___Visa ____Master

Card Number:__________________________________Exp. Date:________

Exact Name on the card:_______________________________

Agreement:

I, the card holder, by signing below authorize Leon Lee Tel/E-O communication to provide phone to phone internet phone service and charge to my credit card when service occurs. I understand that the internet phone is not fully controlable yet.  The service is provided as is.  Leon Lee Tel/E-O communication is  not responsible for internet traffic thus the voice quality.  This authorization remains effective until the account is cancelled.

Signature:___________________________ Date:___________
(required for all applicants)