Application for Xantic Two-Stage Access service

Please fax the completed form to Xantic Customer Services
Fax: / Via Customer Services in Australia: +61 7 5498 0098

For quality reasons please do complete this form in capital letters only

1. Name and address of prospective user of Xantic’s Two-Stage Access service:
Company name
Contact person
Address
Postal Code/ZIP Code
City
State

Country

Telephone number
Fax number
VAT number
(only for companies in the European Union registered for VAT)
Xantic Account Nr.
(for existing Xantic customers)
Please confirm my registration via*:
E-mail - address:
Fax - faxnumber:

* please check the appropriate box

2. Payment
To whom and which address should the bills be sent? / Same as in question 1
To a different address (please provide details below)
Company name
Contact person
Address
Postal Code/ZIP Code
City
State
Country
3. Service description
The Xantic Two-Stage Access service provides access via the terrestrial network to mobile -A, -B, -M, mini-M, GAN and Fleet terminals in the AOR-East, AOR-West, IOR and POR. With Xantic Two-Stage Acces, the connection is split in two parts. The first part is a connection from your phone to Xantic (The Netherlands). The second part is the connection via the Xantic network to the mobile terminal. Xantic customers will receive a specified bill for the (airtime) services used via Xantic and communication charges are per minute in US$.
Following the approval of the application, Xantic will provide the Customer with a PIN-Code in order to access the Xantic network. If you use the Two-Stage Service, you are responsible for maintaining the confidentiality of your PIN-Code and for restricting access to it, and you agree to accept responsibility for all activities related to the use of your PIN-Code, including but not limited to all financial obligations that result from the usage of your PIN-Code. Xantic and its affiliates reserve the right to refuse service, terminate accounts, remove or edit content, or cancel orders in their sole discretion. The user of the Two-Stage Service agrees not to impersonate any other person or entity or use a false name or a name that he is not authorised to use. The user of the Two-Stage service shall notify Xantic immediately of any unauthorised use of its PIN-Code or any breach of security of which the owner becomes aware.
4. Acceptance
This Customer Registration Form is part of Xantic Terms & Conditions for Inmarsat & Value Added Services, previously signed by the Customer. For more information on conditions and tariffs call Xantic Customer Services, Tel.: +31 70 343 4543 (The Netherlands) or +61 7 5498 0000 (Australia).
Name contracting party or assignee: / City: / Date: / Signature:
Remarks Xantic Sales:
For more information visit our website www.xantic.net or email to
Access via the Netherlands
Tel: +31 70 343 4543
Fax: +31 70 343 4796 / Access via Australia
Tel : +61 7 5498 0000
Fax: +61 7 5498 0098
Telex: (71) 22432 TELCSC AA

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