Customer Information

Company Name:
President/Manager:
Email Address:
Address:
City:
State:
Zip Code:
How many locations will we be serving? (i.e. how many buildings?)
(Note: This may not correspond to the # of MOH units you will need)

Service Level:

Premium - Up to 6 Scripts Per Production, Unlimited Updates Per Year, Male AND Female Voice
$79.95/month per location

Equipment Choice:

Manual Load Equipment - You will locally load an audio file we send you.

Music:

Please Select one of the following Musical Styles for your FREE generic production that will come with your equipment:
EZ Listening Country Rock Jazz Piano Blues Big Band

Notes: (Optional)

Installation

Please arrange system installation and setup for me. I understand there will be an additional charge for this service, and that the amount will depend on my local conditions.

I will arrange for installation through a private contractor or an on-site employee.

Agreement:

Please sign me up for the Harris Communications, Inc. (HCI) On-Hold advertising program indicated above. By submitting this form and indicating that I have agreed to it, I promise to pay the monthly fees pursuant to that program for at least the next 24 months. These fees will be billed ahead, quarterly. I acknowledge that HCI will keep my credit card on file and will automatically charge the amount due. After the initial subscription period I will continued to be billed at the current rate for the service level above until and unless I notify HCI or its assigns and or successors in writing or by telephone that I desire to cancel this service, cease to use any audio created by HCI, and send back all HCI equipment in my possession at that time, if equipment has been provided. I understand that my cancellation will be effective upon receipt of the equipment in good working order by HCI, and that I will be responsible for paying all bills through the month in which the equipment is returned. I also understand that I will be charged an initial processing fee of $179 per location, which covers all shipping & handling charges for my entire program along with various expenses associated with starting my service. I understand that this fee is not a purchase price for physical equipment or intellectual property of any kind.