Please check all amounts that you authorize AVC to charge.

[_____] Set Up Fee: * __$25.00__

[_____] Monthly Mailbox Rental Fee: ** __________ per mailbox

[_____] Monthly Usage Fees: ** $___________ per minute for mailbox usage; ___________ per minute for toll free, outcall and paging; __$.10__ per page for Fax Mail; _____________for local access number

[_____] Refundable Deposit: * ____________________

[_____] Other Amount: * ___________________ Description: ______________________________________

*Set Up Fee, Refundable Deposit and Other Amounts are one-time fees

** Monthly Mailbox Rental Fee and Monthly Usage Fees will be charged on a monthly basis within the first 10 days of each month. Each charge will reflect the next month’s Monthly Mailbox Rental Fee and the previous month’s Monthly Usage Fees. One month advanced written notice is required to cancel services..

I agree to pay the above charges according to the card issuer’s agreement. I understand that my signature on this contract will serve as my authorization on the credit charge slip and as a signature on file for all authorized charges and outstanding balances now and in the future. I understand that using a credit card fraudulently is illegal and charges will be pursued to the full extent of the law.

Signature: __________________________________________ Date:__________________________________

Your Contact Phone Number:__________________________________________________________________

Please note that Charges will appear from AVC Voice Mail on your credit card statement.