Application For Telecom Services

Government ID and Credit Card required

Between DCI Telecom, Box 62, Saint-Laurent, Quebec, H4L 4V4, and the Customer as identified below
Application For Telecom Services Between DCI Telecom, Box 62, Saint-Laurent, Quebec, H4L 4V4, and the Customer as identified below
Are you applying for residential or business services?
If you checked "business" please list the name here
Enter your first & last name
Enter your street address
Enter your City, Province & Postal Code
Enter your phone number
Enter your fax number
Enter your cellular number
a valid email is required
to ID yourself when you call us
How did you hear about DCI?

Applications without full credit disclosure will be rejected.

CONFIDENTIAL CREDIT INFORMATION
Please provide some information about your business
What date did the business start?
Name of the owner
What does the business sell?
Your Federal or Provincial business number
Do you rent or own your office?
How much credit do you need with DCI? Be realistic. If you ask for too much you could get rejected.
Last years business sales numbers
What do you do?
helps with the credit check
MM/DD/YYYY
What's your annual income?
How would your rate your credit score?
Do you pay your bills on time?
Do you max out your credit?
Credit Card Authorization - (No gift cards, pre-paid cards)
All accounts must be secured with a credit card and pass a validation transaction and reversal. Name on card MUST be same as applicant.
We will not charge your card unless your account is overdue or you instruct us to charge your card.
By providing my credit card number, I hereby authorize DCI Telecom Inc. and/or its assignee, to debit the credit card indicated above for all overdue payments or any other amounts ensuing from this agreement, if necessary to do so, for the whole duration of this contract. Each charge shall be treated the same as if I had personally issued a written direction authorizing DCI Telecom Inc. to bill/charge the amount specified to the above-listed credit card account
Services To Activate
Choose all services you wish to activate

If 1+ Access is selected, I authorize DCI Telecom or its assignee, to switch my primary long distance service to DCI and to notify my local telephone company to effect the change. I agree to pay the monthly access charge indicated above and confirm that I am at least 18 years of age and authorized to make changes on the above lines. I understand that this authorization switches all direct dialed long distance calls to DCI Telecom
Shared Toll Free numbers are a great way for family members to stay in touch. Business toll free allows your customer to call you and is essential for every successful business.
Please list all phone numbers FROM which calls will ORIGINATE sperated by a comma
Please list your top 5 countries where you call most

DSL speed is limited to 6 Mbps downstream and 800 kbps upstream.
One year term contract. $6.95 modem rental. 8/1 = 8Mbps down and 1Mbps upstream. 15/10 = 15Mbps downstream and 10Mbps upstream etc...

One year term contract. Internet MUST be with DCI for best performance ($3 / month surcharge if not DCI). Equipment must be returned at end of the service term in original packaging. Taxes and 911 service cost extra.
Add unlimited long distance calling to your local line

Pick a service option
Do you want to transfer your current fax number?

Pick a TV service (choose Internet speed below)
Choose your speed. Pricing and speed varies as technology permits. $6.95 modem rental.
Choose additional channels
Taxes and 911 service cost extra.
check all options you require (standard shipping is 2-3 weeks)

choose a service plan
Sign for 2 years and get a subsidized phone
To get a subsidized phone you MUST have a cell number with DCI or transfer a number to DCI
Who is your provider and what is your account number? If DCI then say so.
check all options you require (standard shipping is 2-3 weeks)

TERMS AND CONDITIONS OF SERVICE
DCI Telecom Inc., Box 62, St. Laurent, Quebec, Canada, H4L 4V4
By clicking the submit button below, I, the undersigned, confirm that I wish to subscribe to DCI Telecom services and certify that all above information is true and complete. I authorize you to obtain and exchange personal credit information on myself and my business, with any credit reporting agency, credit bureau, or any of my creditors for the whole duration of this contract. I understand that this order is subject to acceptance by DCI Telecom Inc. I agree to read and be bound by the Terms and Conditions of the respective DCI Telecom product or service selected, which are listed below. Long Distance Wireless VoIP phone lines I will not disclose my PIN number, access code(s) and/or instructions to any third party, and understand that use of DCI's services shall evidence receipt and constitute acceptance of the terms and conditions of such agreement. I understand that a 10 cents usage fee is charged to prepaid accounts on days that I use the service. This contract shall be governed by the laws of the Province of Quebec. All notices given under this agreement must be in writing and must be delivered to DCI Telecom Inc. or the customer at the respective addresses set out on the front of the agreement, or such other addresses as the parties hereto notify each other in writing. It is the express wish of the parties to use the English version of this contract and that this agreement and any directly or indirectly related documents be drawn up in English. Les parties ont exprimé la volonté expresse d’utiliser la version anglaise de ce contrat et que cette convention et tous les documents s'y rattachant directement ou indirectement soient rédigés en anglais.
Please check your email inbox after you click the SUBMIT button. If you are a new customer, you MUST reply to this email and send us a copy of your photo ID. Applications without ID will not be processed.