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(646) 862-9199

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Residential Phone Service Business Phone Service

Residential High Speed Business High Speed

ValoJen Systems Inc.

Initial Order Form - Items with the asterisk are required

Customer Information:

First Name*

Last Name*

Company Name

Contact Telephone 1*

Contact Telephone 2

Contact Email*

Address where service will be provided:

Which Area Code would you need?*

Street*

City*

State* Zip*

Referred by

Referrer's ID

I am 18 years or older

I am authorized to place this order

A ValoJen Systems representative will contact you shortly to confirm your order and obtain your billing information.

Discounts and discounted calls on packages offered applies to unlimited plans only and does not apply to Cell Phones Numbers or to Special

Services Numbers such as Toll-Free or Caller-Paid Information Services or 900 Numbers, and is limited only to the locations identified in the

packages and are when offered are valid for Unlimited plans only. In reference to unlimited minutes, ValoJen Systems adheres to its

Acceptable Use Policy which residential and business customers are encouraged to take note, as it makes reference to normal, excessive and

acceptable use of the unlimited minutes. Unlimited calling and other services are based on normal residential use. ValoJen Systems 911

(E911) functions differently from that of the traditional 911 service. For more information on how ValoJen Systems 911 service works, see

http://www.valojen.com/valojen911.htm. ValoJen Systems phone rates exclude: activation fees, regulatory recovery fees, 911 fees and cost

recovery, premium services, equipment, taxes, termination, shipping charges, directory assistance or broadband service. International calls

are charged per minute. ValoJen Systems phone rates may vary by region. Prices are subject to change. High Speed (broadband) Internet

connection and a credit card required for ValoJen Systems phone services. ValoJen Systems VoIP service may not work with all systems.