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<title>AA Sign Up Form</title>
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<td valign="top"><div align="center"><center><table
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<td width="50%"><font color="#000000"
size="2" face="Arial, Arial, Helvetica">Du
befinder dig nu på en såkaldt '<em><strong>Sikker
Server</strong></em>', hvor al
information bliver krypteret inden det
sendes videre. (Hængelåsen nederst i
din browser er nu låst)</font><p><font
color="#000000" size="2"
face="Arial, Arial, Helvetica">Hvis du
stadig ikke føler dig sikker, så </font><a
href="
http://www.global-gateway.com/download.htm" target="dskaerm.htm"><font size="2"
face="Arial, Arial, Helvetica">gå hertil</font></a><font
color="#000000" size="2"
face="Arial, Arial, Helvetica"> og få
tilmeldingsformularen tilsendt med posten
eller download den og fax, eller send den
hertil</font></p>
</td>
<td width="50%"><p align="center"><a
href="
http://global-force.com/thawte_logo.htm" target="_blank"><font color="#000000"
face="Arial, Arial, Helvetica"><img
src="
https://www.thawte.com/certs/server/stamp.gif" width="150" height="101"></font></a></p>
</td>
</tr>
</table>
</center></div><p align="left"><font
color="#000000" face="Arial, Arial, Helvetica"> </font></p>
<p align="left"><font color="#000000"
face="Arial, Arial, Helvetica"><img
src="images/thin_red.gif" width="520" height="2"></font></p>
<form action="--WEBBOT-SELF--" method="POST"
name="AAorder" onsubmit>
<!--webbot bot="SaveResults"
s-email-format="TEXT/PRE"
s-email-address="info@global-gateway.com"
b-email-label-fields="TRUE"
b-email-replyto-from-field="TRUE"
s-email-replyto="Email Address"
b-email-subject-from-field="FALSE"
s-email-subject="On-line AA order"
s-builtin-fields="REMOTE_NAME REMOTE_USER HTTP_USER_AGENT"
u-confirmation-url="
http://www.global-gateway.com/taktilmeldt.htm --><h3><font color="
#000000" size="3"
face="Arial, Arial, Helvetica" --><p>Generel
Information </p>
<p><font color="#000000" size="2"
face="Arial, Arial, Helvetica"><input
type="text" size="30" name="Client Name">Navn<br>
<input type="text" size="30"
name="Company Name">Evt. Firma navn<br>
<input type="text" size="30"
name="Billing Address">Adresse<br>
<input type="text" size="20" name="City">By<br>
<input type="text" size="20"
name="Postal Code">Postnummer<br>
<input type="text" size="20"
name="Country">Land<br>
<input type="text" size="20" name="Phone">Telefon
nummer<br>
<input type="text" size="20" name="Fax">Fax
nummer<br>
<input type="text" size="20"
name="Email Address">E-mail Adresse</font></p>
<p align="left"><font color="#000000"
size="2" face="Arial, Arial, Helvetica"><img
src="images/thin_red.gif" width="520"
height="2"></font></p>
<h3><font color="#000000" size="3"
face="Arial, Arial, Helvetica">Service
Information</font><font color="#000000"
face="Arial, Arial, Helvetica"><br mstheme>
</font></h3>
<table border="0" cellpadding="0"
cellspacing="0" width="100%">
</table>
<p><font color="#000000"
face="Arial, Arial, Helvetica"><input
type="text" size="8" name="Expected Usage">
</font><font color="#000000" size="2"
face="Arial, Arial, Helvetica">Forventet
månedlig forbrug i US$.</font></p>
<p><font color="#000000" size="2"
face="Arial, Arial, Helvetica"><select
name="Language Request" size="1">
<option>Engelsk</option>
<option>Spansk</option>
<option>Tysk</option>
<option>Fransk</option>
<option>Mandarin</option>
<option>Russisk</option>
<option>Italiensk</option>
<option>Koreansk</option>
<option>Portugisisk</option>
<option>Cantonesisk</option>
<option>Ungarnsk</option>
<option>Hollandsk</option>
</select> Sprog på systemets
automatiske menu</font></p>
<p align="left"><font color="#000000"
size="2" face="Arial, Arial, Helvetica"><img
src="images/thin_red.gif" width="520"
height="2"></font></p>
<h3><font color="#000000" size="3"
face="Arial, Arial, Helvetica">CallBack Numre</font></h3>
<p><font color="#000000" size="2"
face="Arial, Arial, Helvetica">CallBack numre
(Numrene som opkald vil blive foretaget fra -
Hvis mere end 6 numre, så brug venligst
kommentar feltet nedenfor)</font></p>
<table border="0" width="350">
<tr>
<td align="right" width="15"> </td>
<td align="center"><p align="center"><font
color="#000000" size="2"
face="Arial, Arial, Helvetica">Lande<br>
kode </font></p>
</td>
<td align="center"><p align="center"><font
color="#000000" size="2"
face="Arial, Arial, Helvetica">Telefonnummer</font></p>
<p align="center"><font
color="#000000" size="2"
face="Arial, Arial, Helvetica">(Evt.
lokal nummer) </font></p>
</td>
</tr>
<tr>
<td align="center" width="15"><font
color="#000000" size="2"
face="Arial, Arial, Helvetica">1</font></td>
<td align="center"><p align="center"><font
color="#000000" size="2"
face="Arial, Arial, Helvetica"><input
type="text" size="3"
name="Country Code 1"> </font></p>
</td>
<td align="center"><p align="center"><font
color="#000000" size="2"
face="Arial, Arial, Helvetica"><input
type="text" size="20"
name="Phone Number 1"> </font></p>
</td>
</tr>
<tr>
<td align="center" width="15"><font
color="#000000" size="2"
face="Arial, Arial, Helvetica">2</font></td>
<td align="center"><p align="center"><font
color="#000000" size="2"
face="Arial, Arial, Helvetica"><input
type="text" size="3"
name="Country Code 2"> </font></p>
</td>
<td align="center"><p align="center"><font
color="#000000" size="2"
face="Arial, Arial, Helvetica"><input
type="text" size="20"
name="Phone Number 2"> </font></p>
</td>
</tr>
<tr>
<td align="center" width="15"><font
color="#000000" size="2"
face="Arial, Arial, Helvetica">3</font></td>
<td align="center"><p align="center"><font
color="#000000" size="2"
face="Arial, Arial, Helvetica"><input
type="text" size="3"
name="Country Code 3"> </font></p>
</td>
<td align="center"><p align="center"><font
color="#000000" size="2"
face="Arial, Arial, Helvetica"><input
type="text" size="20"
name="Phone Number 3"> </font></p>
</td>
</tr>
<tr>
<td align="center" width="15"><font
color="#000000" size="2"
face="Arial, Arial, Helvetica">4</font></td>
<td align="center"><p align="center"><font
color="#000000" size="2"
face="Arial, Arial, Helvetica"><input
type="text" size="3"
name="Country Code 4"> </font></p>
</td>
<td align="center"><p align="center"><font
color="#000000" size="2"
face="Arial, Arial, Helvetica"><input
type="text" size="20"
name="Phone Number 4"> </font></p>
</td>
</tr>
<tr>
<td align="center" width="15"><font
color="#000000" size="2"
face="Arial, Arial, Helvetica">5</font></td>
<td align="center"><p align="center"><font
color="#000000" size="2"
face="Arial, Arial, Helvetica"><input
type="text" size="3"
name="Country Code 5"> </font></p>
</td>
<td align="center"><p align="center"><font
color="#000000" size="2"
face="Arial, Arial, Helvetica"><input
type="text" size="20"
name="Phone Number 5"> </font></p>
</td>
</tr>
<tr>
<td align="center" width="15"><font
color="#000000" size="2"
face="Arial, Arial, Helvetica">6</font></td>
<td align="center"><p align="center"><font
color="#000000" size="2"
face="Arial, Arial, Helvetica"><input
type="text" size="3"
name="Country Code 6"> </font></p>
</td>
<td align="center"><p align="center"><font
color="#000000" size="2"
face="Arial, Arial, Helvetica"><input
type="text" size="20"
name="Phone Number 6"> </font></p>
</td>
</tr>
</table>
<p><font color="#000000" size="2"
face="Arial, Arial, Helvetica"><br>
</font></p>
<p align="left"><font color="#000000"
size="2" face="Arial, Arial, Helvetica"><img
src="images/thin_red.gif" width="520"
height="2"></font></p>
<h3 align="left"><font color="#000000"
size="3" face="Arial, Arial, Helvetica">Betaling
via Kreditkort</font></h3>
<div align="center"><center><table border="0">
<tr>
<td><p align="left"><font
color="#000000" size="2"
face="Arial, Arial, Helvetica"><input
type="radio" checked
name="Card Type" value="VISA">VISA
<img src="images/Visa.gif" width="63"
height="40"><br>
<input type="radio"
name="Card Type"
value="Mastercard">Euro/Mastercard
<img src="images/Mcard.gif"
width="60" height="38"><br>
<input type="radio"
name="Card Type" value="Amex">American
Express
<img src="images/Amex.gif" width="61"
height="39"><br>
</font></p>
</td>
</tr>
</table>
</center></div><p align="left"><font
color="#000000" size="2"
face="Arial, Arial, Helvetica"><input
type="text" size="23" name="Card Number">
Kort nummer<br>
<input type="text" size="23"
name="Expiration Date">
Udløbsdato (Expires)<br>
<input type="text" size="23"
name="Name on Card"> Navn som
anført på kort<br>
<input type="text" size="23"
name="Issuing Bank"> Bank der
har udstedt kortet</font></p>
<p align="left"><font color="#000000"
size="2" face="Arial, Arial, Helvetica">Hvis
adressen, tilknyttet kortet, er anderledes en
den ovenangivne, så angiv den venligst
her:</font></p>
<p align="left"><font color="#000000"
size="2" face="Arial, Arial, Helvetica"><input
type="text" size="30" name="Client Name1">Navn<br>
<input type="text" size="30"
name="Company Name1">Evt. Firma navn<br>
<input type="text" size="30"
name="Billing Address1">Adresse<br>
<input type="text" size="20" name="City1">By<br>
<input type="text" size="20"
name="Postal Code1">Postnummer<br>
<input type="text" size="20"
name="Country1">Land<br>
<br>
</font></p>
<p align="left"><font color="#000000"
size="2" face="Arial, Arial, Helvetica"><img
src="images/thin_red.gif" width="520"
height="2"></font></p>
<h4 align="left"><font color="#000000"
size="2" face="Arial, Arial, Helvetica">Hvor
har du hørt om Global Gateway ?<br mstheme>
<br>
<input type="text" size="39" name="T1"></font></h4>
<p align="left"><font color="#000000"
size="2" face="Arial, Arial, Helvetica"><img
src="images/thin_red.gif" width="520"
height="2"></font></p>
<h4 align="left"><font color="#000000"
size="2" face="Arial, Arial, Helvetica">Primære
opkaldslande og kommentarer</font></h4>
<p align="left"><font color="#000000"
size="2" face="Arial, Arial, Helvetica"><textarea
name="Comments" rows="5" cols="45"></textarea></font></p>
<p align="left"><font color="#000000"
size="2" face="Arial, Arial, Helvetica"><img
src="images/thin_red.gif" width="520"
height="2"></font></p>
<p align="left"><font color="#000000"
size="2" face="Arial, Arial, Helvetica"><b>Agreement</b></font></p>
<p align="left"><font color="#000000"
size="1" face="Arial, Arial, Helvetica">Sending
this form gives Access Authority the right to
charge my credit card for all services and
calls made by me or anyone authorized by me
using my account number. I acknowledge that
my credit card will be charged each week for
the total of my weekly usage of
Global-Force.com 's services , and that <b>these
transactions will appear on my credit card
statement as "Access Authority."</b></font></p>
<p align="left"><font color="#000000"
size="1" face="ARIAL">The subscriber hereby
agrees to pay the total amount due on each
Access Authority invoice or its designated
agent(s). The undersigned states that all
above statements are true and complete and
are made to obtain long distance telephone
service. The person signing this agreement is
duly authorized and directed to execute this
agreement. The implied warranties of
merchantability and fitness for any
particular purpose(s) are hereby disclaimed
and excluded. </font></p>
<p align="left"><font color="#000000"
size="1" face="ARIAL">We shall not be liable
to the subscriber or any third party for any
special, incidental or consequential damage.</font></p>
<p align="left"><font color="#000000"
size="1" face="Arial, Arial, Helvetica">I
understand I am sending my credit card
information on the internet.</font></p>
<p align="left"><font color="#000000"
size="2" face="Arial, Arial, Helvetica"><b>Agreement
to terms</b> </font></p>
<p align="left"><font color="#000000"
size="1" face="Arial, Arial, Helvetica"><b>By
typing your name in the "Electronic
Signature" below, and pressing the
"Send" button below, you hereby
agree to the Terms and Conditions above and
hereby authorize all expenses associated with
this account. Additionally, any charges are
authorized to be billed, when due, to this
account.</b></font><font color="#000000"
size="2" face="Arial, Arial, Helvetica"><br>
<br>
<input type="text" size="24" name="T2"> </font></p>
<p align="left"><font color="#000000"
size="2" face="Arial, Arial, Helvetica"><input
type="checkbox" name="3a_agree"
value="YOU HAVE AGREED TO THE TERMS AND CONDITIONS OF THE AGREEMENT ON THE PREVIOUS PAGE. IF YOU DO NOT AGREE TO THOSE CONDITIONS, PLEASE CONTACT US IMMEDIATLY!">
</font><font color="#000000" size="1"
face="Arial, Arial, Helvetica">Jeg accepterer
disse forhold for servicen</font></p>
<h4 align="left"><font color="#000000"
size="2" face="Arial, Arial, Helvetica">VENLIGST
CHECK AL INFORMATION OMHYGGELIGT FØR AT
TRYKKE SEND.</font></h4>
<p align="left"><font color="#000000"
size="2" face="Arial, Arial, Helvetica"><input
type="submit" name="Send" value="Send"></font></p>
</form>
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