Service Request
Click Here to Download>>
Contact Information
Contact name
*
:
Address
*
:
City/State
*
:
Zip
*
:
Email address
*
:
Phone
*
:
Cell:
Business Information
Name
*
:
Description:
Services Requested
Mail Box only:
$55
Telephone Answering Package*:
$95
Virtual Office Package:
$175
Executive Office Package*:
$279
Other Services
Mail forwarding~:
$7
Evening access card:
$15
Telephone Set-up Fee*:
$149.99
Additional Phone Line:
$25
Telephone to be answered as:
Additional Requests:
Service Start Date:
Payment Information
$
0.00
Initial Month $
0.00
Thereafter
Credit Card
Visa
Master Card
Discover
American Express
Exp:
01
02
03
04
05
06
07
08
09
10
11
12
/
2009
2010
2011
2012
2013
2014
First Name
Last Name
Address
Address 2
City
State
Zip/Postal Code
Country
Andorra
}
United Arab Emirates
}
Afghanistan
}
Antigua & Barbuda
}
Anguilla
}
Albania
}
Armenia
}
Netherlands Antilles
}
Angola
}
Antarctica
}
Argentina
}
American Samoa
}
Austria
}
Australia
}
Aruba
}
Azerbaijan
}
Bosnia and Herzegovina
}
Barbados
}
Bangladesh
}
Belgium
}
Burkina Faso
}
Bulgaria
}
Bahrain
}
Burundi
}
Benin
}
Bermuda
}
Brunei Darussalam
}
Bolivia
}
Brazil
}
Bahama
}
Bhutan
}
Burma (no longer exists)
}
Bouvet Island
}
Botswana
}
Belarus
}
Belize
}
Canada
}
Cocos (Keeling) Islands
}
Central African Republic
}
Congo
}
Switzerland
}
Côte D'ivoire (Ivory Coast)
}
Cook Iislands
}
Chile
}
Cameroon
}
China
}
Colombia
}
Costa Rica
}
Czechoslovakia (no longer exists)
}
Cuba
}
Cape Verde
}
Christmas Island
}
Cyprus
}
Czech Republic
}
German Democratic Republic (no longer exists)
}
Germany
}
Djibouti
}
Denmark
}
Dominica
}
Dominican Republic
}
Algeria
}
Ecuador
}
Estonia
}
Egypt
}
Western Sahara
}
Eritrea
}
Spain
}
Ethiopia
}
Finland
}
Fiji
}
Falkland Islands (Malvinas)
}
Micronesia
}
Faroe Islands
}
France
}
France, Metropolitan
}
Gabon
}
United Kingdom (Great Britain)
}
Grenada
}
Georgia
}
French Guiana
}
Ghana
}
Gibraltar
}
Greenland
}
Gambia
}
Guinea
}
Guadeloupe
}
Equatorial Guinea
}
Greece
}
South Georgia and the South Sandwich Islands
}
Guatemala
}
Guam
}
Guinea-Bissau
}
Guyana
}
Hong Kong
}
Heard & McDonald Islands
}
Honduras
}
Croatia
}
Haiti
}
Hungary
}
Indonesia
}
Ireland
}
Israel
}
India
}
British Indian Ocean Territory
}
Iraq
}
Islamic Republic of Iran
}
Iceland
}
Italy
}
Jamaica
}
Jordan
}
Japan
}
Kenya
}
Kyrgyzstan
}
Cambodia
}
Kiribati
}
Comoros
}
St. Kitts and Nevis
}
Korea, Democratic People's Republic of
}
Korea, Republic of
}
Kuwait
}
Cayman Islands
}
Kazakhstan
}
Lao People's Democratic Republic
}
Lebanon
}
Saint Lucia
}
Liechtenstein
}
Sri Lanka
}
Liberia
}
Lesotho
}
Lithuania
}
Luxembourg
}
Latvia
}
Libyan Arab Jamahiriya
}
Morocco
}
Monaco
}
Moldova, Republic of
}
Madagascar
}
Marshall Islands
}
Mali
}
Mongolia
}
Myanmar
}
Macau
}
Northern Mariana Islands
}
Martinique
}
Mauritania
}
Monserrat
}
Malta
}
Mauritius
}
Maldives
}
Malawi
}
Mexico
}
Malaysia
}
Mozambique
}
Namibia
}
New Caledonia
}
Niger
}
Norfolk Island
}
Nigeria
}
Nicaragua
}
Netherlands
}
Norway
}
Nepal
}
Nauru
}
Neutral Zone (no longer exists)
}
Niue
}
New Zealand
}
Oman
}
Panama
}
Peru
}
French Polynesia
}
Papua New Guinea
}
Philippines
}
Pakistan
}
Poland
}
St. Pierre & Miquelon
}
Pitcairn
}
Puerto Rico
}
Portugal
}
Palau
}
Paraguay
}
Qatar
}
Réunion
}
Romania
}
Russian Federation
}
Rwanda
}
Saudi Arabia
}
Solomon Islands
}
Seychelles
}
Sudan
}
Sweden
}
Singapore
}
St. Helena
}
Slovenia
}
Svalbard & Jan Mayen Islands
}
Slovakia
}
Sierra Leone
}
San Marino
}
Senegal
}
Somalia
}
Suriname
}
Sao Tome & Principe
}
Union of Soviet Socialist Republics (no longer exists)
}
El Salvador
}
Syrian Arab Republic
}
Swaziland
}
Turks & Caicos Islands
}
Chad
}
French Southern Territories
}
Togo
}
Thailand
}
Tajikistan
}
Tokelau
}
Turkmenistan
}
Tunisia
}
Tonga
}
East Timor
}
Turkey
}
Trinidad & Tobago
}
Tuvalu
}
Taiwan, Province of China
}
Tanzania, United Republic of
}
Ukraine
}
Uganda
}
United States Minor Outlying Islands
}
United States of America
}
Uruguay
}
Uzbekistan
}
Vatican City State (Holy See)
}
St. Vincent & the Grenadines
}
Venezuela
}
British Virgin Islands
}
United States Virgin Islands
}
Viet Nam
}
Vanuatu
}
Wallis & Futuna Islands
}
Samoa
}
Democratic Yemen (no longer exists)
}
Yemen
}
Mayotte
}
Yugoslavia
}
South Africa
}
Zambia
}
Zaire
}
Zimbabwe
}
*Denotes a required field.
~per occurrence + postage *One time set-up fee $149.99 includes programming of telephone line and voice mail. Calls over 100 per month are $.039 each. Long distance calls are billed at cost. Administrative and other support services are available on an as need basis. All virtual office packages are 90 day minimum initial terms then month to month. Conference rooms are billed in one (1) hour increments. No minimum reservation required for monthly members. Non-members a (4) four hour minimum reservation is required. 24 hour notice is required for any cancelled or rescheduled reservation or 1 hour will be charged to your account. – Prices subject to change without notice.
© 2008 BLE Business Solutions, Inc. All Rights Reserved.
