Seafarers' House - Phone Card Agent Application

Phone Card Agent Application

Title

Date of Application Year Est.

Contact Name

Agency Name

Mailing Address

UPS Shipping Address

Phone Number

Postal Country

Please Choose One:

Chaplain Phone Card Agent Commercial Phone Card Agent

Credit Reference

Email Address

Port Name
(if applicable)

Religious Affirmation(s)
( if applicable)

Comments & Questions:

Conditions Governing Phone Card Distribution

PLEASE NOTE: Before submitting this form, please read the following terms and conditions. Seafarers' House distributes pre-paid telephone debit cards (hereafter referred to as "Phone Cards"). We supply phone cards to agents who have ordered a specific quantity for activation. Agents are responsible for payment of their activated phone card stock within 15 days of our shipment after which late charges will apply.

I have read and agree to abide by the stated terms and conditions, upon approval of this Agent Application.