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 service?
Enter your first & last name
Enter your street address
Enter your City, Province & Postal Code
Enter your phone number
Your fax number
Your cellular number
a valid email is required
choose a "secret code word" to ID yourself when you call us
How did you hear about DCI?
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
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. 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.