Holder's address

Holder's address

Mr. Mrs.

Contact

Contact

Subscription

Subscription

Subscription Phone 5+ Phone 4+ Phone 3+ Phone

Nbr of included phone num.

- +

Desired activation date*

Duration of the contract 12 month 24 month

Total incl. VAT per month

CHF 89

Phone number

Phone number porting

Phone number porting New numbers to be allocated Porting the numbers of another provider

Current carrier*

List of numbers to be carried*

Comments

Invoicing

Invoicing

Receive the invoice*

email

post

Payment by

Inpayment slip (QR) LSV / Direct debit

General terms and conditions*

I declare that I have read the General Terms and Conditions of Telco Pack SA and certify that all the information provided by me in this form is true and accurate.
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