Customer Details Company Name: First Name: * Last Name: * Phone Number: * Email Address: * Video Conference Details Date & time of conference: * Time zone: * --- (GMT +12:00/+13:00) New Zealand (GMT +8:00) WA (GMT +9:30/+10:30) SA (GMT +9:30) NT (GMT +10:00/+11:00) ACT, NSW, VIC, TAS (GMT +10:00) QLD Other Timezone/Location Estimated Duration of Conference: * ---012345678 Hour(s) and ---00153045 Minute(s) Connection type: * ---IPISDNMixed Number of locations: ---12345678910 All Connection Details Location 1 Location Contact name Mobile number Connection type---IPISDN IP Address / ISDN Number Location 2 Location Contact name Mobile number Connection type---IPISDN IP Address / ISDN Number Location 3 Location Contact name Mobile number Connection type---IPISDN IP Address / ISDN Number Location 4 Location Contact name Mobile number Connection type---IPISDN IP Address / ISDN Number Location 5 Location Contact name Mobile number Connection type---IPISDN IP Address / ISDN Number Call monitoring required? * *Additional charges apply. Call monitoring provides you with advanced support from a dedicated operator for the full duration of your event. ---YesNo Do you require a test call or run through? ---YesNo If so, please specify a date for Chorus Call to confirm(extra charges may apply)---12345678910111213141516171819202122232425262728293031 ---JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Additional Information: * I accept Chorus Call's Terms & Conditions and confirm that information above is accurate. Δ
