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Referred by :  105239 

 Company Name *
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 Address *
 Address (additional) 
 City *
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ZIP/Postal Code *
Telephone *
E-Mail Address *

Internet Access 

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(Letters and Numbers Only, minimum 6 characters)
 Password * (Minimum 7 characters)
 Re-enter Password *
Please write here a question and answer in case if you forgot your password

Secret Question *

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Service Preferences and Registered Numbers
Service     CALL BACK
Call Back Telephone Number *

* North American numbers start with 1 . For example 19058049111
* Other international numbers with 011 . For example 011441231234567

 Language of Preference *

Billing Preferences
Select Payment Method :    HELP
Credit Card  (recommended option)
Wire Transfer 
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Pay Pal
( NOTE: TelCan will only accept Paypal payments with a confirmed shipping address. )
Select Account Type :
Post-Paid Account 
          Please specify weekly credit Limit US$

Prepaid Account
(recommended option)
          Purchased Amount in US$
Credit Card Information (if Payment Method is Credit Card)

Card Number *

Expiry date *


 Name on Card *

Address on Credit Card
(if different from above, otherwise leave blank)




Zip/Postal Code  

Credit Card Transaction will be processed through Internet Secure.
Please read Internet Secure Privacy Policy and Term of Use for further information

By submitting this form I hereby request telecommunications services from Telcan Inc. I authorize Telcan Inc. to charge my credit card indicated above for all obligations contracted from the services ordered. All charges are in US Dollars. I confirm that I have read and that I understand the sales agreement
and that I agree to accept the policies and statements within it. I hereby agree to accept sole liability for the payment of all charges of Telcan Inc. services regardless of whether access permission was granted by myself. Telcan Inc. reserves the right to refuse service. I hereby agree that Telcan Inc. will not be held responsible for any losses or damages as a result of problems with the service rendered. I hereby give permission to Telcan Inc. to use my email address given in this application to send information strictly related to Telcan Inc. This authorization is to remain in effect until Telcan Inc. receives written notification from the undersigned to cancel this authority.

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than once as it will create multiple accounts

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