form of application

Please, complement with black pencil in block letters and fax in: 928145531 ,

or send by post in Call by Call Canarias S.L., Edificio Info Canarias, Calle San Salvador,
E-35109 El Tablero de Maspalomas

 Name:

Given Name:

Company:

Residencia-identity card, tax identity card or identity card number:

Street:

 

Recommended from:

 

1010 -10765

Post Code:            City:

 

Tel.:

Fax:

E-Mail:

           

Please, switch my following Tel. / fax numbers freely:

 

Calculation by: E-Mail      __    FAX   __        Post  __       ( please mark )

Bank name:

Account:

 

_ _ _ _

_ _ _ _

_ _

_ _ _ _ _ _ _ _

 (20 figures)

Entidad

Oficina

DC 

Account number

 

Herewith I authorise                        (name of account holder)

Call by Call Canarias S.L., all CBC phone calls perfect by me to debit from my account.

Signature :                                      City                    Date