Today's Date:________________________________

Credit Card Information:        [ ] Visa        [ ] Mastercard        [ ] Discover        [ ] AmEx

Account Number: ________________________________________________________

Expiration Date: ______________________________

Name on Account: _______________________________________________________

Phone: ________________________________________________________________

Fax: __________________________________________________________________

Billing Address: _________________________________________________________

Email Address: _________________________________________________________

Promotional Code _______________________________________________________


By signing this agreement, I authorize Bow Communications to charge the above account
with the following option:

[ ] $50      [ ] $75      [ ] $85      [ ] $95      [ ] $100      [ ] $125      [ ] $150      [ ] $175   

Per month for Conference call Services with Bow Communications. I understand that I am
reserving a line and I agree not to charge back whether I actually use the line or not for each
month that I am an active participant with Bow Communications. All Charges are processed
in advance on the 15th of the month. To cancel service please notify in writing before the 15th
of the month, thank you.

Authorized Signature: ____________________________________________________