Satellite Service Agreement

  *required for credit card purchase or billing

978-828-2181

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Dealer Name

Application Number

Dealer ID Number

Account Number

Individual Subscriber Information
Home Address
   

First Name

Last Name

Street

City

State

Zip

Home Phone

Work Phone

Email

Fax

SS #

 

 

Date of Birth

(MM/DD/YY)

 

 
Home Billing Address (if different than above)
   

Street

City

State

Zip

Company Information

Company Name

Contact Name

Street

City

State

Zip

Contact Phone

Tax Exempt

No  Yes 

Industry Type

Federal Tax ID:

Company  Billing Address (if different than above)
   

Street

City

State

Zip

Activation Information

Satellite Phone No.

Electronic Serial #

Service Plan

Features  Voice Mail   Call Forwarding

Contract Term

   
       

Credit Card

Card No.

Name as it appears on card

Please type your full name in the box below. By doing so and submitting this form to Triad Marine you are agreeing to the terms and conditions set forth by Triad Marine.
 

Terms & Conditions. The person submitting this form agrees: (a) to keep the phone service selected by Triad Marine Ltd. for 180 days from activation date; and (b) not to deactivate or change the telephone number(s) assigned to him or her during said 180 day initial term. If the undersigned violates either of these conditions he or she agrees to pay Triad Marine liquidated damages from the credit card listed above in the amount of $500 per telephone number. At the end of the initial term the agreement will convert to a month-to-month term.

For more information about Triad Marine products and services, please contact:

 

Triad Marine
5 Haskell Court
Gloucester, MA 01930
978-828-2181