WORLD ACCESS (SM) Callback Service Authorization   Agent Number: P-8200-000 
Company/Name __________________________________________________________ 
Address _________________________________________________________________ 
City, State _______________________________________________________________ 
Country _______________________________________Postal Code________________ 
Billing Address ___________________________________________________________ 
City, State _______________________________________________________________ 
Country _______________________________________Postal Code________________ 
Contact Name __________________________Phone __________ Fax ______________ 
e-mail (important) _________________________ (if e-mail is not your own circle >here<) 
VOICE PROMPTS [ ] English [ ] Spanish [] PORTUGUESE   Other:_______________  
# SECURITY CODES ____ AUTO ROUTE Ext ____ 
CREDIT CARD   [ ] VISA     [ ] MC     [ ] AMEX 

Card # __________________________________________________ Expires ________ 

Name Exactly as on Card ___________________________________________________ 
Issuing Bank _______________________________________ Credit Request ________ 
List all phone #'s for which you desire service - include an OPTIONAL extension: 
+CountryCode-CityCode-PhoneNumber/Ext  +CountryCode-CityCode-
PhoneNumber/Ext  

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AGREEMENT: I, the card-holder, by signing, agree to pay and specifically authorize the 
company (or its Designee) to charge for and request a creditallowance for long distance 
telemanagement services up to an amount per monthequal to the credit requested as stated 
above.    I understand that the company may obtain a credit card authorization, aweekly 
credit amount based on the monthly figure, but will only charge foractual services, after 
they have been rendered.  (Weekly credit amount is anestimate of the charge).  I 
understand that my credit card may be charged everyweek for actual usage incurred.  I 
further agree that in the event my creditcard becomes invalid, that I will provide the 
company with a valid credit cardnumber upon request and have charged, or pay, any/all 
outstanding balances owedto the company.  All charges will appear as Access Authority or TerraCom
on my bill.    
Disputes must be made in writing (return receipt requested) or via fax nolater than 30 days 
after receipt of invoice.  I agree that any disputes will notbe cause for withholding 
payment and that I must pay all invoices in fullregardless of any disputes being negotiated.  
All credits, if any, issued forresolution of disputes will be applied to the current billing 
cycles invoice inwhich the dispute is resolved.Authorized Signature 
______________________________________ Date _______________Print Name 
_________________________________Title ______________________________