To join A'lpha1, just print this application form, fill in 1-12 in English, then fax or mail it to us (the address is below). Service is usually ready 1 or 2 business days after we receive an application. We then email and post your new account information to you. There is no fee to join A'lpha1. If you can't print this application contact us and we'll send it to you.
A'lpha1 Application Form
- NAME: ________________________________________________________
- ADDRESS: _____________________________________________________
_______________________________________________________________
___________________________________ POSTAL CODE______________
Credit card billing address if different from above:
_______________________________________________________________
- TEL: _______________________________________
TEL: _______________________________________
FAX: _______________________________________
- EMAIL: _______________________________________________________
- REGISTER TELEPHONE NUMBERS:
A ___________________________________________
B ___________________________________________
C ___________________________________________
D ___________________________________________
E ___________________________________________
Register the numbers you will call from, not to (you can call to any number). For example, you might register your home phone, your fax, and your mobile phone. Include area code. Copy this form to register more numbers.
- LANGUAGE: English Japanese
IR ID#: 5601
- CREDIT CARD TYPE:: Visa JCB MasterCard AmEx
- CARD NUMBER: ____________________________________ CODE*: ____
*The 3-digit number at the end of your card number on the back of your credit card. If there is no 3-digit number check here: ______
- EXPIRATION DATE: _______________
- CARDHOLDER NAME: __________________________________________
AUTHORIZATION: I (We) do hereby authorize World Link* to charge the total amount of my World Link bill to my credit card number as listed above and to request a credit allowance for long distance telemanagement services. I understand that I will only be charged for services after they have been rendered. I understand that I will receive a monthly statement of call details only if my usage is at least ¥2000 for that period. I understand that I have 30 days from the date of receipt of the call details to dispute any charges and that all disputes must be in writing via mail to Alpha Rise / World Link, Shibuya Ibis Biru 6F, Shibuya 2-17-3, Shibuya-ku, Tokyo 150-0002. I further agree that in the event my credit card becomes invalid I will provide World Link with a valid credit card upon request and will pay any and all outstanding balances owed to World Link. This authorization is to remain in effect until written notification from the undersigned to cancel this authority is received by mail at the World Link address shown above. *World Link is the name of A'lpha1's carrier.
- CARDHOLDER SIGNATURE: _____________________________________
- DATE: _______________
- HOW DID YOU FIND OUR WEBSITE? ______________________________
(Yahoo search for "Telephone" etc.)
Fax or mail this application to:
A'lpha1
Maehara-cho 4-17-26, Koganei-shi, Tokyo 184-0013
Tel: (042) 388-5958 Fax: (042) 388-1918
www.Alpha1.com
