Agora Solution

Today's Date

Cell phone dead? No coins? No calling card? Need to call home? Never be lost again! Call Toll free
anytime for help reaching your loved ones!

Make Unlimited toll free and long-distance calls using the Safety Network for only $8.23 a month!

Call toll free to family and friends and leave a message! That message will be instantly emailed to
      them! Need to speak with someone right away? Call them directly through the same toll free number
      without incurring additional long distance charges! You can make unlimited long distance calls and
      speak with them live if you need to using the same toll free number!

Coming soon: International Toll-free at no extra charge!

Agorasolution Safety Network, allows you to check your messages from anywhere in the United States. Your friends and family will be able to leave you messages using your own toll-free number. Agorasolution Services can also send reminder calls and wake-up calls from anywhere in the continental USA. No credit check or long-term contract is required and you can cancel at any time by calling toll-free 1-800-679-7386. For Questions or Cancellation, simply call customer service toll-free at 1-800-679-7386.

AgoraSolution is authorized to provide and bill its services by way of your electronic signature. Once submitted, this electronic order constitutes an electronic order of agency authorized by your electronic signature in accordance with specific terms and conditions. Agorasolution reliance on your electronic signature, as obtained herein, was specifically sanctioned and written into law when Uniform Electronic Transactions Act (“UETA”) and the Electronic Signatures in Global and National Transactions Act (“E-Sign”) were enacted in 1999 and 2000, respectively. If you wish to cancel the service and /or have any questions please call 1-800-679-7386 or write to AgoraSolution at PO BOX 50480, Minneapolis, MN 55405.

* All fields are required!

First Name:	Last Name:	Address:	City:	State:
Zip:	Billing Phone: (No Cellular Phone) ( ) — —		Date of Birth:
Email Address:		Gender:
Last 4 of SSN:

By clicking the “Yes ” I Accept, box, I confirm the information submitted and my authority to incur charges on the telephone number listed above. I am 18 years of age or older and I understand and fully accept the terms and conditions of this offer and AgoraSolution. I understand and agree that AgoraSolution will submit a $8.23 monthly fee to your local telephone bill. Your first AgoraSolution bill will be in the amount of $8.23 regular monthly fee. Thereafter, if I do not cancel, AgoraSolution will automatically submit the monthly service fee of $8.23 to my local telephone bill each month until I cancel my account. AgoraSolution is in not affiliated with a local telephone company. By completing and submitting your order, you consent to having all disclosures provided or made available to you in electronic form and to doing business with AgoraSolution electronically in conjunction with pre-established methods of business.

Yes No	Are you at least 18 years of age and are authorized to make changes and/or incur charges to this telephone account?
Yes No	Do you understand and agree that you are giving your authorization for AgoraSolution to bill your local phone bill in the amount of $8.23 each month for this service?
Yes No	Do you understand this charge will appear in your local telephone bill on the bill page, billed on behalf of AgoraSolution?

You have the right to dispute the AgoraSolution charges billed on your local telephone bill. As a telephone company subscriber, you are not legally responsible for AgoraSolution charges incurred by minors or vulnerable adults without your consent. Neither a long distance company nor your local exchange company may disconnect your local telephone service because you refuse to pay a AgoraSolution charge.

AgoraSolution services are considered enhanced telecommunications services. You have the right to dispute enhanced telecommunication service charges billed on your QWEST telephone bill. As a telephone service subscriber, you are not legally responsible for enhanced telecommunications service charges incurred by minors or vulnerable adults without your consent. Neither a long distance company nor QWEST may disconnect your local telephone or long distance service because you refuse to pay an enhanced telecommunications service charge. Enhanced telecommunications service providers may employ other agencies to collect delinquent service charges, even if QWEST has previously adjusted them from your telephone bill.

By checking this box I confirm I have read and agree with the terms and conditions of this offer.