Myjapanphone special program-get special coupon and special price, Japan cell phone rental.

Please download the order form and complete it,
then fax to us at 1-732-412-4040

NOTICE
1. This page is hosted on a private server with a secure connection, which encrypts your information, keeps it private and protected. 2. Please complete and submit the secured online order form,a confirmation e-mail will be sent to you shortly. 3. If reserve multiple phones, please submit orders separately. Thank you.

Coupon Code ( What is the coupon code ):

I want to Rent

Cell Phone

BlackBerry

BlackBerry + Cell Phone

Optional Service:
Activation Option ( Email, Internet, SMS, MMS )	YES($10)	NO
Insurance:	YES ( $1/day,with $120 deductible )	NO

Customer Information

Gender*	Mr.	Ms.
First Name*
Last name*
Home/Office Phone Number*
Email Address*
( E-mail address is required for order confirmation and other communications )

Delivery Information

Hotel/Company/Home Receiver Name*
Address
State
Zip Code
Country and City:
Phone (Of your hotel or contact person)*
Date(The date you want to receive phone)*	/ /

Drop-off Information How to choose rental date?

	Return to USA: please mail the phone to our USA office at your own expense. (Cost: $0)
	Drop off in Japan: drop off in postbox or hotel by prepaid labeled envelope. (Cost: $15)

Date( The date you return phone )*

/ /

Payment Information


VISA	MASTERCARD	AMEX	JCB	DISCOVER

Name on the card*
Card number*
Expiration Date*	/
Security Code*
Special Instruction regarding your order
Please tell us where do you first heard about MyJapanPhone: (This information helps us greatly. Thank you )

Agreement

I have read and agree with MyJapanPhone terms and conditions; I accept responsibility for all the equipment received. By signing below, I authorize MyJapanPhone to charge the above credit card for all applicable shipping and rental fee, usage charge and other fees as specified in MyJapanPhone Terms and Conditions.

Signature of Cardholder:*

BlackBerry option:
	Blackberry Enterprise Service	Blackberry Internet Service
Please enter your email account and password / enterprise activation code, if you want MyJapanPhone to help you set up on BlackBerry device:
BlackBerry Insurance:	YES ( $2/day,with $300 deductable )	NO