TOURFONE LLC.
16455 SIERRA ST FOUNTAIN VALLEY, CA 92708-2105, USA
Tokyo office: 1-2-2-1007, Kudan-Kita, Chiyoda-Ku, Tokyo, Japan 102-0073, Phone: 011-81-3-3263-7040

Fax: 1-877-218-5834(U.S)/011-81-3-3263-6071(Japan)/011-86-10-85952213(China)
  * Required Information

Application of Rental Phone Service in Japan

ACCOUNT
User Name ___________________________ (optional)  
Password ___________________________ (optional)  
Email ___________________________  
Tourfone uses email to confirm your reservation, sending urgent message and reciepts of service fees, so please type it correctely
PROFILE
Family Name ___________________________ *
Given Name ___________________________ *
Street Address ___________________________ *
City ___________________________ *
State/Province ___________________________ *
Country U.S.         Japanese         Other *
Zip/Post Code ___________________________ *
Home Phone ___________________________ *
Work/Mobile Phone ___________________________  
Age ___________________________ *
Gender M                 F *
Occupation ___________________________  
Language English         Japanese         Chinese *
Passport Number ___________________________ *
PICK UP/RETURN
To ensure timely delivery, reservation must be made in advance at least two business day for Tokyo city area and 3 business days for other cities. For urgent requests, please contact Tourfone Tokyo office.
PICK UP
Contact/Hotel Name ___________________________ *
Street Address ___________________________ *
City ___________________________ *
Contact Phone Number ___________________________ *
Fax ___________________________  
Date (yy/mm/dd) ___________________________ *
Time ___________________________ *
RETURN
Contact/Hotel Name ___________________________ *
Street Address ___________________________ *
City ___________________________ *
Contact Phone Number ___________________________ *
Fax ___________________________  
Date (yy/mm/dd) ___________________________ *
Time ___________________________ *
PREPAID RENTAL FEE
Tourfone's service charge is calculated as the sum of P & H fee, phone rental fee and prepaid calling fee as well as delivery fee. You must pay for your order in advance with your credit card and overage of your prepaid calling fee will be charged to your credit card too.
Processing Fee $10  
Phone Rental Fee

$2/day with $10 minimum

  
Shipping fee $20  
Calling Plan A         B         C         D         E *

Prepaid Calling Fee
Rate Table
Incoming
 Domestic Int'l to US
A. Emergency Plan $29.50
Free
 $1.00/min $1.60/min
B. Traveler Plan $49.50
Free
 $0.80/min $1.20/min
C. Business Plan $89.50
Free
 $0.70/min $1.10/min
D. Executive Plan $159.50
Free
 $0.60/min $1.00/min
E. Longterm Plan $299.50
Free
 $0.50/min $0.90/min

Accidental insurance Yes         No     ($1/day with $5minimum) *
* With this insurance, you will not be liable for the cost of repairing the phone, and the replacement cost will be $100 less if the phone is stolen or damaged beyond repair.
Call lists & Order confirm by fax Yes         No     ( $5 service fee) *
Fax number ___________________________  
CREDIT CARD
Type of the Card Amex Visa MC JCB *
Name of the Card Holder ___________________________ *
Card Number ___________________________ *
Expiration Date ___________________________ *
Tourfone will report credit card fraud crime to authority and impose $ 200 for invalid credit card information.
I herewith authorize Tourfone to charge my credit card for the above service and additional calling fees should it incur.
Signature__________________________ Date_______________
08/19/2005