ZyTrax Internet Services Agreement

Print this form, sign it (or have it signed), fax it to us at (514) 285 8523. We will give you a committed date for service start when we sign and return this form. Use the guidance notes when filling in the agreement. Please read our Terms and Conditions before signing.

Company Details
1. Company Name	_____________________________________________
2. Address	_____________________________________________
3. Address (continued)	_____________________________________________
4. City, Province	_____________________________________________
5. Postal Code	_____________________________________________
6. Telephone	_____________________________________________
7. Fax	_____________________________________________
Contacts
10. Technical Contact Name	_____________________________________________
11. Telephone (extension)	_____________________________________________
12. Billing Contact	_____________________________________________
13. Telephone (extension)	_____________________________________________
Billing Information
20. Billing Address	_____________________________________________
21. Billing Address (continued)	_____________________________________________
22. City, Province	_____________________________________________
23. Postal Code	_____________________________________________
24. Telephone	_____________________________________________
Internet Information
30. What is your Domain Name	_____________________________________________
31. Select a preferred Domain Name	_____________________________________________
32. Domain type(s) required	_____________________________________________
33. Do you have ISDN lines now	_____________________________________________
34. Do you have an ISDN router	_____________________________________________

Services Required

Access Services	Service Code(40)	Qty(41)	Price Each (42)	One-time (43)	Monthly (44)
50. Primary Plan
51. Access Options
51. Access Options
52. Static IP addresses
53. Access Total	N.A.	N.A.	N.A.
E-Mail Services
60. Email Plan
61. E-mail Options
62. E-mail Total	N.A.		N.A.
70. Router Rental	RR1
71. Option Total				N.A.
Totals
80. Prepayment	N.A.
81. Services Total	N.A.	N.A.	N.A.

Notes:

1. All applicable taxes will be charged at the prevailing rates.
2. A setup charge  equal to 1 month's billing is applicable to all Access Services, after 6 months of continuous service the Setup charge will be credited to your account.
3. I understand that ZyTrax, Inc. is not liable in any way for any lost profits or other indirect, special, consequential or punitive damages arising from the provision of the services ordered in this agreement.
4. I have read and understood the ZyTrax Terms & Conditions of Service prevailing at the time of signing this agreement. 
5. I understand that if, within 30 days, of receiving service I wish to terminate the service then I am entitled to a full refund of the Setup charges and any other monies paid on commencing the services in this agreement. I understand that this refund will be paid on return of any rented equipment or equipment supplied at No Charge as part of this service(s) agreement.
6. I understand that rental equipment and equipment supplied at No Charge as part of the services defined in this agreement remain the property of ZyTrax, Inc. and must be returned if I terminate the service.
7. I understand that I may terminate this services agreement at any time after the first 30 days by giving 30 days notice in writing.

Signatures

90. For (Company)	____________________________	For	ZyTrax, Inc.
91. Name (print)	____________________________		____________________________
92. Signature	____________________________		____________________________
93. Date	____________________________		____________________________
94. Service Start	____________________________		____________________________

May we thank you for doing business with ZyTrax, Inc. ( www.zytrax.com)

ZYTRAX Inc. 70 rue Notre Dame West, suite 301, Montreal, QC, Canada H2Y 1S6 Tel:514-285-9088