totoongpinoy.com

Family Ties Application Form

Fill out application

Applicant's Information

* Applicant's Name:

* Address (Including Postcode) :

Telephone

* Cellphone:

* Landline:

* Email Address:

Employment Information

* Employer's Name:

* Address:

* Position:

* Contact No.:

* Years with Employer:

Beneficiary's Information

* Beneficiary's Name:

* Complete Address (Philippines):

Please include barangay name.

Landmarks (for ease of identification of address):

* Contact Telephone No.:

Phone Number Registration

Please register the phone number that you will call the service from. It can be landline or cell phone number.

Landline Cellphone

Payment Requirements

Payment can be made thru:

cheque OR credit/debit card

to cover the total amount shown below:

Monthly Recurring Charge = US$ 39.95 One-Time Installation Fee LEC One month advance + One-Time Fee US$ 35.00 TOTAL = US$ 74.95 WIRELESS One month advance + One-Time Fee US$ 100.00 TOTAL = US$ 139.95

Applicant's Confirmation

I also agree to be bound by the Terms and Conditions

Name:

Date:

Our sales agent will contact you if the beneficiary is serviceable. Please contact our customer service for more information: 1-800-530-5634.