Thank You - Fax EMR Confirmation - Unite Communications

Your Unite Reference Number

At Unite Communications, we build custom telecommunications solutions to meet the unique needs of your business. Please fill in the following form and one of our representatives will follow-up with you shortly.

General Information

Full Company Name*

Main Contact Name*

First Last

Phone*

Ext.

Email*

Address

Main Address*

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

Let's set up your Unite Fax EMR Account.

The following questions will help us with setting up your account.

Approximately how many fax pages do you send and receive a day?

Are we porting a number?*

Yes
No

What city and province do you require a local fax number for?

City State / Province / Region

Please enter the number here*

Number will port in 7-10 days, unless you specify a port date 10-30 days ahead.

We require a copy of your most recent phone bill*

I'd like to upload an attachment now
I'd like to fax my most recent phone bill
I don't currently have a copy, I will send it later

Please attach a copy of a current phone bill.*

Accepted file types: pdf, jpg, jpeg, png, Max. file size: 20 MB.

Please fax us a copy of your most recent phone bill.

Fax us at 1-866-341-5550.

Please note your reference number on all faxed forms. Your reference number is located at the top of this page.

Payment Setup

Step 1 - Select Payment Method*

Step 2 - Complete the Pre-Authorization / Cheque Form

Click here to download the form.

Step 3 - How would you like to submit your payment information?*

By uploading a picture/scan now
By faxing a copy to us

Step 4 - Please upload the completed payment form*

Accepted file types: pdf, jpg, jpeg, png, Max. file size: 20 MB.

Step 4 - Please fax the form to 1-866-341-5550.

Please note your reference number on all faxed forms. Your reference number is located at the top of this page.

Receive SMS Alerts (it's free!)

SMS Alerts

Yes, I'd like to receive special offers and system notifications from Unite via Text messages.

Mobile Phone Number

Enter a mobile phone number to receive Text messages in real-time.

General Questions

Questions / Comments?

Terms and Conditions*

Yes, I agree with Unite's Terms & Conditions found here.

Thank You.

Fax / EMR