Customer Details Company Name: First Name: * Last Name: * Phone Number: * Email Address: * Video Conference Details Date of event: * ---12345678910111213141516171819202122232425262728293031 ---JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember ---201820192020 Conference start time: * 123456789101112:000510152025303540455055 AMPM Conference end time: * 123456789101112:000510152025303540455055 AMPM Time zone: * ---NZST - ends 28/09/2019NZDT - 29/09/2019 to 05/04/2020AEST (QLD, NSW, VIC, TAS, ACT) - ends 05/10/2019ACST (NT, SA) - ends 05/10/2019AWST (WA)AEDT (NSW, VIC, TAS, ACT) - 06/10/2019 to 05/04/2020AEST (QLD) - 06/10/2019 to 05/04/2020ACST (NT) - 06/10/2019 to 05/04/2020ACDT (SA) - 06/10/2019 to 05/04/2020 Connection type: * ---IPISDNMixed Number of locations: ---12345678910 All Connection Details Location 1 Location Contact name Mobile number Connection type---IPISDN IP Address / ISDN Number Location 2 Location Contact name Mobile number Connection type---IPISDN IP Address / ISDN Number Location 3 Location Contact name Mobile number Connection type---IPISDN IP Address / ISDN Number Location 4 Location Contact name Mobile number Connection type---IPISDN IP Address / ISDN Number Location 5 Location Contact name Mobile number Connection type---IPISDN IP Address / ISDN Number Call monitoring required? * *Additional charges apply. Call monitoring provides you with advanced support from a dedicated operator for the full duration of your event. ---YesNo Do you require a test call or run through? ---YesNo If so, please specify a date for Chorus Call to confirm(extra charges may apply)---12345678910111213141516171819202122232425262728293031 ---JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Additional Information: * I accept Chorus Call's Terms & Conditions and confirm that information above is accurate.
