Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Contact us if your needs exceed this form.Name *FirstLastEmail *EmailConfirm EmailEnter your Cell, Landline, SatPhone, or VOIP number(s). You might also choose to protect your IP address. Break down your number into segments representing your country code [if outside the US] region or area code, and phone number.[A] Primary Landline, Cell, SatPhone, or VOIP to be Covered *[B] Additional Landline, Cell, SatPhone, or VOIP to be Covered[C] Additional Landline, Cell, SatPhone, or VOIP to be Covered[D] I.P. Address to be Coveredi.e. Computer, Tablet, etc…[E] I.P. Address to be Coveredi.e. Computer, Tablet, etc…[F] I.P. Address to be Coveredi.e. Computer, Tablet, etc… if to IP Confirm Your Information *My Information Is CorrectBefore proceeding, double check your entered information for completeness and accuracyChoose Service(s)Choose your service and duration using the checkboxes below. [*Only use “Special” if you have been instructed to do so. If you accidentally choose “Special” accidentally, you will not receive this service or a refund.]Based on your entrie(s) above, check the appropriate boxes below[A] 1 year service for primary line – $120.00[A] 2 years service for primary phone – $240.00[A] 5 years service for primary phone – $600.00[B] 1 year service for second phone number – $120.00[B] 2 years service for second phone number – $240.00[B] 5 years service second for phone number – $600.00[C] Additional Phone Protection – $120.00[D] I.P. DEAF Protection – $120.00[E] I.P. DEAF Protection – $120.00[F] I.P. DEAF Protection – $120.00Special 27471-UX – $60.00Special 27472-UX – $60.00Special 27473-UX – $60.00Change Covered Phone Number – $40.00Only use the Change Number option if your phone number changes. You may also choose to extend your coverage by selecting from the check boxes above. With either or both cases, you must enter the covered [or new] number in the “Primary Number” field above, even if it is a second or third phone line. Questions? Contact us using our online contact form.Total Amount$0.00Stripe Credit Card *Confirmation *I acknowledge that I have read and agree to abide by the the Terms and ConditionsI acknowledge that upon submitting this form, my orders are final and can no longer be canceledI understand activation will occur within 7 days of paymentI understand this is NOT a subscription. This service WILL NOT continue past your selected duration unless you resubmit your order.I understand I may change my covered number with a cost of $40Submit
