V D TELECOMMUNICATION INC.

246-15, 86th Road, Bellerose, NY 11426, Phone: 1-718-470-6664 , 1-800-211-3447
Email: contact@vdtelecom.com, http://www.vdtelecom.com


Authorization form for Electronic Fund Transfer Or Credit card charge

Thank you for choosing VDT.. Please fill out this form and fax it to 718-470-6665

 
 
 

Name: _________________________________________________ Email:_______________________
Address:____________________________________________________________________________
Phone: H __________________ W __________________ 
Existing customer?          Yes                  No

 
 

 

VDT Post paid ( Monthly Billing)
9c

 All India, 9c Banglore, Bombay, Chennai, N.Delhi, Calcutta and Hyderabad
10c to Rest of India and cellphones, 20c to UAE & S. Arabia, 10c to Kuwait, 4c to UK and Canada, 3c within USA

 No connection fee, setup fee, maintenance fee or tax. One min. billing
Do not need to change your Long Distance Provider nor to dial a long PIN number. 

Please list the Phone numbers you want to call from:
(Home) ______________________  (Cell)______________________  (Work)  ______________________


How do you want to Pay ?
                Credit Card             Checking Account 
We will charge your account every end of the month as per your usage ( Only for VDT Post paid )

Credit Card Payment:
Credit card # ______________________________________
Credit Card Security Code ________ ( Last 3 digit code on the back of the card and for AMX, 4 digit code on the front )
Credit Card type _____________________ ( Visa / Master / Discover / AMX ) Expiration Date: ______________

Checking Account Payment :
(Please fax us a copy of your check to set up your payment, this is a one time requirement)
Bank Account # __________________________ ABA # _____________________ 
Bank Telephone number (with area code): ________________________ 
* Checks faxed once need not be mailed later on. 

Authorization and Cancellation :
1. I authorize the payment to be charged / deducted from my credit card/bank account every month as reflected in online bill.
2. I understand that if I am not satisfied with service I may cancel payment authorization anytime after I payoff my usage.
3. I understand that if any reason my payment is returned, I agree to pay all collection costs, including attorney fees.

Signature: ___________________________                                               Date:____________________