Once you have filled in all your details and submitted the application, you will be contacted on the number you provide on this form. Once contacted and payment has been received, your application will be finalized and processed.

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Service Details:


Dolphin Plans
(select one)


STANDARD DOLPHIN PLANS - VoIP Phone Service Only
Dolphin Basic - $10.95/mo
Dolphin Province Wide - $19.95/mo
Dolphin World - $29.95/mo.
Dolphin World Wide Plus - $39.95/mo.

FREEDOM PLANS - Highspeed Internet and Phone Bundled
Basic Freedom Plan - $39.95/mo.
BC Freedom Plan - $44.95/mo.
World Freedom Plan - $54.95/mo.
Extreme Freedom Plan - $64.95/mo.


Billing Details:

Name
Address
City/Town Province Postal Code
Phone (H)
Phone (W)
Fax
Email Addresses
Create A Password Used to access the Dolphin Account Manager. Minimum of 6 characters and must contain at least two of the following elements: upper case letters, lower case letters, or numbers.

Dolphin Equipment:

Select equipment you require for service.

Payment Details:

Payment Method Credit Card Bank Debit
Cash/Cheque
(If paying by cash or cheque, residential customers must pre-pay at least 3 months at a time)
Credit Card Expiry
(We accept Visa, Mastercard, and American Express.)
Card or Account
Holder Name
Bank Debit
(Please enter your 5 digit branch number, 3 digit bank number, and your account number.)

Dolphin Staff:

Please let us know how our staff performed so we can better assist people in the future.

Your Salesperson:    BEST WORST

Authorization:

Please note that ADSL services are not available in all areas or on all lines due to technical network constraints. There may be special hardware installation required at additional cost in some residences. Please allow a minimum 6 business days for the provisioning of your service. If paying by credit card or bank debit, your card will be auto-debited each month for the subsequent month's access. There is NO CHARGE if we cannot provision ADSL on your line.

Once an order has been confirmed, it can only be cancelled within 24 hours. Once provisioning and activation is complete the account becomes active immediately and billing commences immediately. Due to technical reasons this cannot be delayed.

I acknowledge that this is a prepaid service and the first month and hardware sales will be charged today. All monthly fees are payable on or before the 1st of each service month.

Prices indicated for the various plans do not included applicable taxes, tariffs, $15.00 set-up fee, or the $4.95 per month network access fee. All prices as well as other aspects of our services are subject to change without notice.

To show your acceptance of and willingness to be bound by the terms and conditions listed at our website, please type your name and tick the box "I AGREE" below and click Submit. Click here to view our complete Terms and Conditions.


Your Full Name        I Agree