Seafarers' House - Phone Card Order Form

Phone Card Order Form

PRODUCTS

QUANTITY

My Approved Agent Name is :

SeaFare Card™

Pre-activated $5 Cards

Pre-activated $10 Cards

Promotional Materials - FREE posters, rate sheets, etc.

Contact Information

Name
Organization
Address
Phone
Fax
Email

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.

* Please fill out the form above and submit to Seafarers' House to process your order.
You may also print this form and fax your request to (954) 734-1590 For questions
regarding the ordering process, please contact us at:

Seafarers' House - Casa Del Marino
Seafarers' House
1850 Eller Drive - #500
Ft. Lauderdale, FL 33316
Phone: (954) 734-1580
Fax: (954) 734-1590
Toll Free: 1-800-732-6367
Email: info@seafarershouse.org