Customer Details Company Name: First Name: * Last Name: * Phone Number: * Email Address: * Video Conference Details Date of event: * ---12345678910111213141516171819202122232425262728293031 ---JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember ---20212022 Conference start time: * 123456789101112:000510152025303540455055 ampm Conference end time: * 123456789101112:000510152025303540455055 ampm Time zone: * ---NZST - ends 26/09/2021NZDT - 27/09/2021 to 03/04/2022AEST (QLD, NSW, VIC, TAS, ACT) - ends 04/10/2021ACST (NT, SA) - ends 04/10/2021AWST (WA)AEDT (NSW, VIC, TAS, ACT) - 05/10/2021 to 03/04/2022AEST (QLD) - 05/10/2021 to 03/04/2022ACST (NT) - 05/10/2021 to 03/04/2022ACDT (SA) - 05/10/2021 to 03/04/2022 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.
