i-Tel Long Distance

Online Sign Up

Required Fields *

Last Name *

Example: Tanaka

First Name *

Example: Sandra

Company Name

Example: i-Tel KK
This only needs to be completed if you are applying as a corporation.

Address that the bill and detailed statement will be sent to:

Address*

Example: 907 Tokyo Haitsu

Example: 1-2-3 Meguro

Ku/Gun/Shi*

Example: Meguro-ku

Prefecture*

Example: Tokyo-to

Zip*

Example: 123-4567

Contact

Phone* Example: 03-1234-5678
Fax Example: 03-1234-5679

e-mail

Example: japan@i-tel.com

How did you hear about i-Tel?

Please give the name of the magazine or newspaper

List the number(s) you wish to place calls from

Example: 03-1234-5678
Example: 090-1234-5678

How would you like to receive your statement?

e-mail

regular mail

Credit Card Details

Card Type *
Card Number *		Example: 1234567890123456
Expiry date *		Month Year Example 01/06 is January 2006
Cardholder's Name `*		Example: Sandra Tanaka

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