Planetfone Rental Application

PlanetFone Rental Application
Complete form and submit, or print form and fax.

Toll Free1-888-988-4777 Toll free Fax 1-888-388-4800

Citi® Platinum Select® / AAdvantage® World MasterCard® cardmembers

Making all
the right
connections.

This application is for Citi® Platinum Select® / AAdvantage® World MasterCard® cardmembers.

All other Citi AAdvantage cardmembers please return to the PlanetFone home page and click on the link for your appropriate card.

First Name*		Last Name*
Company	WE DO NOT DELIVER TO A P.O. BOX ADDRESS
Shipping* Address
City*		State*	Zip*
Phone*		Fax

Billing Address*	Please enter address as it appears on your credit card statement.
City*		State*		Zip*
Phone*			Fax
Email*

Ship PlanetFone to*: Shipping Billing

Phone Delivery Date / /	Activation Date / /	Return Date / /
Orders must be submitted before 4:00 p.m. Pacific standard time for Overnight Shipping. Orders Placed after 4:00 PM (PST) will not ship until next business day. Orders placed Saturday/Sunday will not ship until Monday; earliest delivery Tuesday

If you are going on a cruise please check this box

Check here if you want the package to be left without your signature. If you mark "Yes", then you are accepting full responsibility for the phone and all calls made from the phone.

Optional - One Year Executive Service Plan (call for rates)

	Optional - Check for Data Cord delivery. (Data cord is used to connect laptop to GSM phone for Email and FAX capability)
....Optional - Check here for your 800 Toll free Number what's this
*Quantity of phones ordered

Please list all of the countries you will be visiting
Country 1	Country 2	Country 3

Country 4	Country 5	Country 6

Country 7	Country 8	Country 9

Country 10

Special instructions or notes.
Office use

I authorize PLANETFONE to use my Citi® Platinum Select® / AAdvantage® World MasterCard® account to pay for my cellular phone charges.

Credit Card Number *

Exp. Month*

Exp. Year*

(1234)

(5678)

(9012)

(3456)

Ex. (Feb = 02)
(2 Digit Year)

Ex.(2017 = 17)
(2 Digit Year)

For security purposes, please include the 3 or 4 digit security code (found on the back/front of your card)

3/4 Digit Code*

Name on Card

Billing Address for Credit Card
(Fill out only if different than shipping address)

City

State

Zip

Country of origin ONLY if OTHER THAN U.S.

Mail billing statement to: Shipping Address Billing Address

Please Note: Upon shipment of the cellular phone, a $300.00 authorization will be placed on your designated credit card. Your credit card will be used to process all fees or charges for the rental of the international cellphone. This may take more than one transaction.

Please Note: All prices are in U.S. Dollars.

Please Note: Airtime charges are subject to change. PlanetFone will advise customers of all air time fee changes with an advance notice.

Please Note: The Free Rental Offer is not available in Japan and or Korea. In addition a 5% tax will apply to the rental fees and the airtime charges on Japan and Korea phone orders.

Please Note: Cancellation Policy - If the order is cancelled after PlanetFone ships the equipment, a $20.00 shipping fee will be applied. (Rush shipping charges and shipping charges outside the continental US including Canada are additional and will vary in cost). The customer is also responsible for the $20 return delivery fee.

Statement of Authorization

I hereby authorize PLANETFONE to bill all cellular phone rental charges and airtime fees to my current credit card as directed above. If approved, I understand that any charges billed to my designated credit card will be subject to other charges that appear on the account in accordance with the terms and conditions governing the account. Each time I rent a cellular phone, it will be subject to a credit card authorization before my reservation is confirmed and the cellular phone kit is delivered. If my card status changes, or if my card is lost or stolen, I agree to notify PLANETFONE and the appropriate credit card company immediately. If I elect to terminate this credit card authorization to bill my account, I will notify PLANETFONE and the appropriate credit card Company.

Indicate here as having read, understood, and agree to the Terms & Conditions*
Print Name:*	Date:* / /

* Required Field

Toll Free: (888) 988-4777
Fax: (888) 388-4800
Email: PlanetFone

PlanetFone Terms and Conditions

Program Terms and Conditions