VoIP Satellite Order Form - Houston Media Systems

Thank you for your interest in VoIP Satellite.

Please fill out the following form so we can better assist you.

Thank you for your interest in VoIP Satellite. Please fill out the following form so we can better assist you.
Select the country for your primary phone number
- Mexico
- United States
Select one of the available states for your primary phone number
Select one of the available states for your primary phone number
(Optional) Select the country for your secondary phone number
The secondary phone number is an optional, virtual phone number
Select one of the available states for your secondary phone number
Select one of the available states for your secondary phone number
Select a VoIP satellite plan
(Optional) How will you be connecting to VoIP?
- Dial Up
- Satellite
- DSL
- Cable
Purchase InnoMedia MTA6328 Analog Telephone Adapter (ATA) - $65 + shipping
- Yes ($65 + shipping. Will be sent to shipping address below)
- No (I have an InnoMedia MTA6328 Analog Telephone Adapter)
ATA MAC Address
In which country do you reside?
In which country will you be using VoIP service?
Company Name
Name
First Last
Shipping Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email
After we ship your equipment, you can pay via the following options:
- Wells Fargo Account: 1010180050419
- Citibank Account: 63159617
- PayPal: telefoniasky@aol.com
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