Midwife on-Call - 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*

Mobile Phone*

Mobile Carrier*

Ext.

Email*

Address

Main Address*

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

Let's set up your Midwife on-Call Account

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

Extensions Programming*

Extension #	Name	Initial Number to forward to	Email	Do you require a hosted PBX phone line for this Ext? ($15.95/ month)	Mobile Carrier	Mobile Number

Up to 10 Extensions. If you need an Operator Extension, place "Op" in Extension #.

Do you require additional extensions?*

$6 plus $10 activation per extension

Yes
No

Ok, please list them out.*

Extension #	Name	Initial Number to forward to	Email	Do you require a voice over IP for this Ext ($15.95/month)	Mobile Carrier	Mobile Numer

Additional Local Numbers*

City	Province / State

Number Porting

Are we porting an existing local phone number?*

Yes
No I require a new number

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

City State / Province / Region

Please enter the phone number here*

We require a copy of your most recent phone bill for this phone number*

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

Upload Phone Bill*

Max. file size: 300 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.

Are we porting a toll-free number?*

$9.95 per month, includes 500 FREE minutes per month. Additional minutes 2.9 cents each.

Yes
No, but I'd like a new one
I don't require one

Please enter the toll-free number here*

We require a copy of your most recent phone bill for this toll-free number*

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
My toll-free number is on the same bill as my phone number

Please fax us a copy of your most recent toll-free 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.

Upload Toll-Free Phone Bill*

Max. file size: 300 MB.

Additional Items

Do you require additional local numbers (Canada and US)?*

$7.95 per month each

Yes
No

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.

General Questions

Questions / Comments?

Terms and Conditions*

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