eFax Order Form and Info

Unique ID

Tech Minded Agent Details

This information is used to track the order so it's attributed to you. Please fill it out completely.

Tech Minded Agent ID Number

Tech Minded Agent Name

First Last

Tech Minded Agent Company

Tech Minded Agent Email*

Tech Minded Agent Phone*

Tech Minded Agent Phone Type

Direct Office
Main
Mobile

Client Details for Order

In order to setup services, we need the below information.

Can't complete the form yet, but want to start? No problem -- start the form, and then press "Save and Continue" at the bottom of the page.

Client Company Name*

Client Contact/Signer Name for Contract*

First Last

Client Contact Title

Client Address for Contract*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Client Website

Client Email for Contract*

Client Phone*

Client Phone Type*

Direct Office
Main
Mobile

What type of organization is this client?

What industry or business are they in? Or what is the organization's overall purpose? This information can often reveal interesting choices that are specific to your client's industry or type.

If this is a client request, how did you hear about us?

Technical Contact Details

Often, the technical contact for an organization is different from the contact who signs an agreement. Please provide that contact info as well, if available.

Is the technical contact for this organization different from the person who signs the agreement?

Yes
No
Don't know

Technical Contact for Client

First Last

Technical Contact Title

Technical Contact Email

Technical Contact Phone

Technical Contact Phone Type

Direct Office
Main
Mobile

Standard Plans — Monthly Billing

eFax Plus Billed Monthly

Send and/or Receive up to 150 pages/month. $0.10 per page for pages beyond above (overage). $10 One-Time Setup fee.
Standard Monthly Pricing: Normally: ~~$16.95~~ per user/month. Your price: $14.95 per user/month.

Price: $14.95 Quantity:

eFax Pro Billed Monthly

Send and/or Receive up to 200 pages/month. $0.10 per page for pages beyond above (overage). $10 One-Time Setup fee.
Standard Monthly Pricing: Normally: ~~$19.95~~ per user/month. Your price: $17.95 per user/month.

Price: $17.95 Quantity:

Standard Plans — Yearly Billing

You get 2 months free with Annual Plan, plus additional savings!

eFax Plus Billed Yearly

Send and/or Receive up to 150 pages/month. $0.10 per page for pages beyond above (overage). $10 One-Time Setup fee.
Standard Annual Pricing: Normally: ~~$169.50~~ per user/year. Your price: $149.50 per user/year.

Price: $149.50 Quantity:

eFax Pro Billed Yearly

Send and/or Receive up to 200 pages/month. $0.10 per page for pages beyond above (overage). $10 One-Time Setup fee.
Standard Annual Pricing: Normally: ~~$199.50~~ per user/year. Your price: $179.50 per user/year.

Price: $179.50 Quantity:

Corporate Plans

eFax Corporate Billed Monthly

Send and/or Receive up to 100 pages/month. $0.15 per page for pages beyond above (overage).
Waived! $100 One-Time Setup fee
Standard Monthly Pricing: Normally: ~~$34.95~~ per user/month. Your price: $29.95 per user/month.

Price: $29.95 Quantity:

eFax Corporate Billed Yearly

Send and/or Receive up to 100 pages/month. $0.15 per page for pages beyond above (overage).
Waived! $100 One-Time Setup fee
Standard Monthly Pricing: Normally: ~~$359.40~~ per user/year. Your price: $299.50 per user/year.

Price: $299.50 Quantity:

Type of Number

What type of phone number would you like for your incoming faxes?

Local and toll free numbers, as well as porting, are all included in your price listed above.

Local Number
Toll Free
IPorting Existing Numbers
I have more than one user, the answer varies by user.

Thanks! We'll be asking you more on this below. You can place the order without all the porting documentation to get things started (and that's usually best).

Local Area Codes Requested

Please list the local area codes that you are interested in. There's widespread choices, but we have to verify availability once you submit.

Multiple Number Types

Please describe what you would like for local vs. toll free numbers.

Setup Cost

One time setup fee for all eFax Plus/Pro accounts ordered on this form.

Setup fees are waived for eFax Corporate account orders.

Price: $10.00

Finalize Order

Once all the information above has been filled in, and you've entered the quantities for each SKU, press the "Order" below. This will cause your order to be sent to Tech Minded's backend provider/eFax for processing.

Total to be billed to card provided for your first month.

This includes one-time setup fees, if applicable.

$0.00

Payment Options

Choose your payment type*

Please provide your payment information. You will be charged for the event registration fee indicated above. If you are using a purchase order, please include PO number in the notes field below. Orders without valid payment details will not be processed, and will not be considered "placeholders" for an order or pricing.

Credit Card Number (Visa/MC)*

Credit Card Number (Amex)*

Credit Card Expiration Date (MM/YY)*

Name on Card*

CVV (Security Code for Card) for Visa/MasterCard/Discover*

The three digit code. Typically on the front of the Visa/MasterCard/Discover

CVV (Security Code for Card) for Amex*

The four digit code. Typically on the front of the American Express card.

Purchase Order Number

Payment Notes or comments

Porting In Existing Numbers

Porting numbers is normally fairly quick, but may be delayed if there are a number of requests at the same time. You can immediately call forward numbers in the interim -- talk to us if you have questions. If you are ready to prepare the porting number documents, see porting instructions page for more details.

Do you have numbers to port?

Yes
No
Maybe. Not sure.

Are you ready now to upload porting documents?

Yes
No

File Uploads*

Please upload any porting documents or additional information here. Keep Excel files as an Excel file.

Drop files here or

Other Important Information

Other Project Notes

eFax Order Form and Info

Order Form: eFax Services

Tech Minded Agent Details

Client Details for Order

Technical Contact Details

Standard Plans — Monthly Billing

Standard Plans — Yearly Billing

Corporate Plans

Type of Number

Setup Cost

Finalize Order

Payment Options

Porting In Existing Numbers

Other Important Information

INTERNAL USE: Order Form Submission Details