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Toronto Office:
Sales
(Contact Suthan)
amdmobility@hotmail.com
Customer Service:
info@amdmobility.com
Wireless Service Application Form
Customer Information
First Name:
*
Last Name:
*
Date of Birth:
*
Gender:
Male
Female
Address:
*
City:
*
Province:
AB Alberta
BC British Columbia
MB Manitoba
NB New Brunswick
NL Newfoundland
NS Nova Scotia
NT Northwest Territories
NU Nunavut
ON Ontario
PE Prince Edward Island
QC Quebec
SK Saskatchewan
YT Yukon
*
Postal Code:
*
Phone (Home):
*
Phone (Work):
Email:
*
Credit Information
Card Type:
Select
Visa
MasterCard
American Express
Card Number:
Expire Date:
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01
02
03
04
05
06
07
08
09
10
11
12
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2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
Driver's Licence Number:
*
Driver's Licence Expire Date:
--
01
02
03
04
05
06
07
08
09
10
11
12
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2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
SIN:
Phone and Voice/Data Plan Information
Phone:
*
!
List of phones
Monthly Service Fee:
*
!
List of plans
Term (In Years):
01
02
03
AMD Mobility Security and Privacy Policy
Please review the Security and Privacy statement below.
AMD Mobility Security and Privacy Policy Our Commitment to your Online Security and Privacy: AMDmobility.com has created this privacy statement in order to demonstrate our firm commitment to the privacy of all of our users. 1. Security Statement on Your Personal Information: =================================================== Your Personal Information is Not Shared/Sold and Or Contributed to any affiliate or Third Party. Your email address, Mailing address and phone number or any other personal data is Not Shared/Contributed/Sold to any affiliate or third party. AMDmobility.com strictly adhere's to its Security and Privacy Policy. 2. Emails: ========== Your email box will not be filled with Junk or Spam Emails from our Customer Service Department. Your Email address will Not be sold or contributed to Anyone else. In Case that you have joined WirelessGalaxy.com's Mailing list to Inform you of the latest Sales and Rebates, you will not receive more than 2 Emails per month. That's Our Promise! 3. Zero Tolerance on Online Credit Card Abuse/Fraud: ==================================================== Due to the nature of the business online, we have enforced various processes to prohibit un-authorized use of any credit card member's credit account and personal information. We closely monitor every order. Any un-authorized use of a Credit Card account is a Federal felony, punishable by Fine and/or Prison Term. We, at AMDmobility.com believe in a secure internet for everyone and we want to protect every web user's personal information from web hackers and people who use it for personal advantage. Our Statement is: ' Zero Tolerance on Online Credit Card Fraud! Thank you for your Interest in the Wireless Products of the Fastest Growing Web Portal in the Wireless/Cellular Products and Accessories. AMD Mobility AMDmobility.com 647-408-2223
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