www.jcrcorp.com

JCR CORPORATION

ON-LINE ORDERS     

Fax. 1.808.947.3210 (U.S.A.)   03.5701.9400  (JAPAN)

Print the following form (File/Print) and send it via facsimile.  Return confirmation will be sent by E-mail or facsimile.


U.S.A. Phone Rental Order Form
Reservation Date: (m/d/y): _____/_____/_____

 CUSTOMER INFORMATION

Customer Name ( F/MI/L): _________________________________________________________________
Home Address:  ________________________________________________________________________  

City: _________________________________       State/Prov. _____________________________                   

Zip/Postal Code: _____________________      Country: _____________________                               
Home Phone: (______)______-____________  Bus. Phone: (______)______-____________ 
Fax Number: (______)______-____________     E-mail Address: ____________________________________
SSN# or Passport#: _____________________________   Country: ___________________________________
Business Name (if corporate credit card): ________________________________________________________
Business Address: _________________________________________________________________________________
City: _________________________________       State/Prov. _____________________________
Zip/Postal Code: _____________________      Country: _____________________ 

 DELIVERY & RENTAL INFORMATION

Deliver to:
Business Address    
Home Address    
Hotel:_________________________________________
  DELIVERY DATE (m/d/y): _____ /_____ / _____ 
  ACTIVATION DATE (m/d/y): _____ /_____ / _____
  RETURN DATE (m/d/y): _____ /_____ / _____
U.S.A. Delivery
U.S.A. Regular Delivery Service (allow 72 hrs.)
U.S.A. Overnight Delivery
HawaiiI Delivery and Return
JAPAN Delivery or Return (Pickup or Return your U.S.A. phone in Japan)
JAPAN Regular Delivery
Hotel or other Address: ________________________________________________________________________________
JAPAN Airport Pickup Delivery Service (Narita, Kansai, or Nagoya International Airports $10.00)
Airline: ________________________    Flt. No. ___________   Arrival Time: ______:______   am   pm
JAPAN Regular Return Delivery
Airport Return Delivery Service (Narita, Kansai or Nagoya International Airports $10.00)
Special Requests: _______________________________________________________________________________________
 PAYMENT INFORMATION
Method of Payment:
VISA
MASTERCARD  
AMERICAN EXPRESS
JCB
Select Card Type:
PERSONAL
CORPORATE  
BANK DEBIT
Credit Card Number:
                               
Expiration Date: 
   

  20

   
 Expiration Date must exceed  two months past the return date.
Credit Card Billing Address:      Business Address     Home Address
How did you find us ? _________________________________ Search Engine: _____________________________
Agent: _____________________________________

 AGREEMENT

JAPAN CELL PHONE RENTALS and the customer ("Customer") whose name and signature appear on this agreement agree as follows:
The customer signing below authorizes JCR Corporation d.b.a. Japan Cell Phone Rentals (JCR) to process a credit card voucher in customer’s name for all charges and fees incurred from the rental of cellular equipment. The Customer agrees that all information submitted is true and complete. Title and ownership cellular phone equipment and accessories shall remain at all times in JCR Corporation and you agree that you will not attempt to give away, sell, mortgage, assign, dispose of or encumber said equipment nor will you in any manner impair or permit to be impaired our title to and ownership of said equipment. A deposit may be required for renters residing outside the US or Japan.  Customer agrees to purchase the loss/damage waiver protection which covers equipment from loss, theft or damage. Customer agrees that he is responsible for the first $100.00 (deductible) of costs from equipment loss, theft or damage per phone rented.  All equipment and items included with rental must be returned and in original condition. Japan Cell Phone Rentals may add and Customer agrees to pay a Late Charge equal to 1.5% per month (18% per annum) on past due account balances.

CANCELLATION, NO SHOW, LATE ARRIVAL and REFUND POLICIES: Customer agrees there will be no cancellation charge if cellular equipment rental order is cancelled with Japan Cell Phone Rentals prior to the shipment of the cellular equipment.  Customer agrees that if cancellation notice with Japan Cell Phone Rentals is not received prior to the shipment of the equipment,  the Customer was not at the delivery address, or has been determined to be a "No Show": a three days' rental cancellation charge,  shipping charges, and applicable taxes will be billed to the Customer's credit card.  Cellular equipment rental orders received within 72 hours of the date of rental will not be charged for cancellation if the notice is received prior to the shipment of ordered cellular equipment. The cancellation charge will be waived in cases of equipment not delivered on promised date, upon verification and documentation to Japan Cell Phone Rentals.  Phones not returned by Customer on agreed upon return date will automatically renewed from day to day until receipt of cancellation notice or return of equipment.

Credit Verification, Deposit Requirement, Temporary Service:  Based upon information supplied by Customer, JCR will obtain credit information regarding Customer from trade references and credit reporting agencies.  Based on this information, and other information obtained by JCR, JCR may require Customer to make deposit with JCR.  JCR reserves the right to either refund the deposit if Customer has maintained the account in good standing, or apply the deposit to any balance owed by Customer to JCR.  If JCR refunds the deposit to Customer, said deposit will be sent to Customer by United States first class mail to Customer’s last known address.  JCR may require that any such deposit be increased based on Customer’s usage or changes in Customer’s credit status, or any other valid reason.  At JCR’s sole discretion, Customer may receive Service prior to credit review without waiving JCR’s right to demand security deposit from Customer. Customer shall notify JCR if submitted credit card details change or the credit card has been lost or stolen.  Customer agrees to to notify JCR and the appropriate credit card company immediately.

Access and Telephone Number:  The Customer has no interest in, or claim of right to, the telephone number.  JCR reserves the right to change the telephone number upon two (2) days prior notice, except that in the event of suspected fraud, no notice is required.  A cellular telephone number issued by JCR to Customer under this agreement may not be assigned to, or associate with, another cellular telephone except with the consent of JCR.  If Customer assigns or associates the cellular telephone number to another cellular telephone without JCR’s consent, Customer shall be responsible for all to said telephone number.

Limitations of Liability
:  JCR shall not be liable to Customer for interruptions of service, loss of data, interceptions of cellular transmission, omissions or errors of third parties, equipment failures, acts of god, strikes, government actions, or causes beyond JCR’s reasonable control.  JCR shall not be liable if changes in operations, procedures, or services require modification or alteration of customer’s equipment or render customer’s equipment obsolete.  there shall be no reductions, setoffs, or credits against the charges for service for downtime or interruption of service unless such period exceeds twenty-four (24) consecutive hours from the time of notice of interruption until service restoration is provided to customer.  if service interruption exceeds twenty-four (24) consecutive hours, JCR shall provide customer with a credit allowance equal to the amount payable by customer during the service interruption period, provided customer promptly notified JCR of the service interruption.  JCR shall give no credit for circumstances caused by the negligence or intentional acts or willful misconduct of the customer. In no event shall JCR be liable to customer for incidental, consequential or punitive damages, including, but not limited to, lost profits, loss of use, or loss of business opportunity.  JCR shall not be liable for injury to customer, other persons, or property damage through the use of any equipment or service provided under this agreement

customer indemnity:  CUSTOMER AGREES TO INDEMNIFY, HOLD HARMLESS, AND DEFEND JCR AGAINST ANY CLAIMS RELATED TO CUSTOMER’S MISUSE OF SERVICE OR EQUIPMENT UNDER THIS AGREEMENT.  CUSTOMER AGREES TO REIMBURSE JCR FOR ANY AND ALL COSTS AND REASONABLE ATTORNEYS’ FEES INCURRED BY JCR IN DEFENDING ANY CLAIMS RELATING TO CUSTOMER’S MISUSE OF SERVICE OR EQUIPMENT.

CAUTION:  Tampering with the cellular phone may render the equipment inoperable.  Additional charges may be incurred for 
replacement of or resetting equipment.

The Customer represents he has read, understands, and agree with all conditions set forth herein. This agreement shall be in effect when signed by Customer and accepted by Japan Cell Phone Rentals.  Customer shall pay to Japan Cell Phone Rentals all costs and expenses including attorney's fees, court costs and collection agency fees incurred by Japan Cell Phone Rentals in exercising any of its rights or remedies hereunder or enforcing any of the terms, condition or provisions hereof.  Call data may be used at any time to contact or locate client in cases when credit card is declined or has expired. All information provided here will be kept in strict confidence and shall not be distributed to any other source. Rates as of 10/15/01: Prices subject to change without prior notice.

  Customer Signature  X ____________________________________________________   Date____________________

 

FAX to: 1.808.947.3210

in Japan: 03.5701.9400

 

Japan Cell Phone Rentals respects your privacy. All information you submit to us is kept entirely confidential and is not shared with anyone outside our organization.