TOURFONE LLC.
Main office: 16455 SIERRA ST FOUNTAIN VALLEY, CA 92708-2105 USA
Tokyo office: 1-2-2-1007, Kudan-Kita, Chiyoda-Ku, Tokyo, Japan 102-0073


Fax: 011-86-10-85952213(China Data Center)/ 011-81-3-3263-6071(Tokyo Office)  
Please send your fax to China Data Center for faster processing * Required Information

Application of Rental Phone for use in the U.S.

ACCOUNT
User Name ___________________________ (optional)  
Password ___________________________ (optional)  
Email ___________________________  
Tourfone uses email to confirm your reservation, send urgent messages and receipt of service fees, so please double check.
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 Time and Location

1.) I will pickup/return my rental phone in Tokyo Office at following locations:
1-2-2-1102, Kudan-Kita, Chiyoda-Ku, Tokyo, Japan 102-0073
2.) Ship to my home/office in Japan at following address (pay by addressee):
To ensure timely delivery, reservation must be made in advance by at least 1 business day for Tokyo area and 3 business days for other cities in Japan. For urgent requests, please contact Tourfone Tokyo office. Phone: 011-81-3-3263-7040

Ship to
Contact Name ___________________________ *
Street Address ___________________________ *
City ___________________________ *
Contact Phone Number ___________________________ *
Fax ___________________________  
Rental duration
Date to be delivered ___________________________(yy/mm/dd) *
Time ___________________________ *
Date to be returned ___________________________(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. 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 & Handling Fee $10  
Phone Rental Fee $1/day with 5 days minimum  
Calling Plan A         B         C         *

Prepaid Calling Fee
Rate Table
Domestic/Incoming Int'l
A. Emergency Plan $29.50 $0.48/min $0.90/min
B. Business Plan $89.50 $0.28/min $0.50/min
C. Executive Plan $159.50 $0.20/min $0.40/min

Accidental insurance Yes         No     ($1/day with $5 minimum) *
* 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 detail lists by fax Yes         No     ($5 service fee) *
Fax number ___________________________  
Referrer ID ___________________________  
CREDIT CARD
Type of the Card Amex Visa MC JCB Diners *
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 services and additional calling fees should it incur.
Signature__________________________ Date_______________

11/24/2006