Telcotel Customer Registration Form   First Name       Last Name       Address       City       State       Postal Code       Phone no.(s) to override       Contact Number      E-mail Address       Reference No.    NDS01 Manager, Sales and Marketing Telcotel, BSS Insight Pty Ltd Dear Sir, This is to state that I have read and understood Telcotel's terms and agree to be bound by them. As I am very interested in your call overriding facility and services, I wish to give my full consent in obtaining your Call Overriding facility (1428) to the above mentioned phone number(s). I am fully aware that my current (1428) call override service provider whom I am already subscribed to will be discontinued hence forth and I have no objection to that. Please be kind enough to set up my call override (1428) account with BSS Insight Pty Ltd with immediate effect. Thank you, (Customer Name) _______________________      Date: ____________ (Customer Signature) Fax the completed form to Telcotel at (03) 9011 9434