Amber Telcom is a trading name of Amber Pro Inc.  reg. 509072 BVI
Amber Telcom, 17 Ensign House, Admirals Way, Docklands
            London   E14 9XQ   England
      Telephone London ++44  (0)207 681 3960
    Telephone New York ++1 (212) 214-0688

emailsupport@ambertel.com

APPLICATION FORM For Niche Template Option


 
 





Full Name 


Address 
 
 


Telephone Number 
Fax Number 
e.mail 

*** Multi Site Template = £100

***Multi Site Template + casino + swingers= £200

*** Multi Site Template + casino + swinger+ sextoys= £300 


What name would you require 
your commissions sent in 
(social security number required for US residents)

Total Enclosed Payment
Cheques (checks)Payable to Amber Pro Inc.
see other payment methods below

 
 

    Your Signature(s)                                                      Date 
 
 

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PLEASE PRINT THIS APPLICATION
AND SEND IT TO US WITH YOUR CHEQUE

Wired Bank Transfer or Telephone Banking: 
Our Bank Name: Alliance & Leicester Commercial Bank 
Our bank Address: Bootle, Merseyside, GIR 0AA, UK
Account Number: 0128 1526
Sort Code: 72-00-00
BIC:  ALEIGB22

TRANS CASH (Uk only) 
Payment can be made through  any UK post office using the Trans Cash system
Simply pick up a Trans Cash Form, fill in the details and hand it accross the counter with your payment

Details to complete on Trans Cash Form:
Account Number: 12 815 26
Name of Organisation: Amber Pro Inc
Your Name and Address
Reference Number: 14785NICHE

The application form should be posted to us with your payment or can be FAXED if paid directly into our account along with proof of payment, please email us if you have any questions.

 

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