Reserve your Amigo Today

    Customer Information
    Choose Billing Plan:
    First Name*
    		 Last Name*
    Street Address*
    Street Address 2
    City *
    		 State
          		 Postal Code *
    Home Phone (no spaces) *
    Cell Phone
    		 Fax
    E-Mail *
     
    Phone Rental
    Date of arrival in Israel
    Return Date (on ticket)
    Address in Israel
    School/Program name
    School/Program Phone Number
    Number Phones Required:
    Car charger required (no charge):
    Phone Preference (subject to availability): Motorola i265
    Motorola i90c
    Motorola i730
    What is your child's Amigo cell phone number?
    Billing Information Copy from Customer Info
    Cardholder First Name
    		 Cardholder Last Name
    Address
    City
    		 State
          		 Zip
    Credit Card Type
    		 Credit Card Number
     
    Credit Card Expiration
    		 CVV2 What is CVV2?
    How would you like to receive your bill?
    Email Mail ($2 fee for US mail)
    Shipping Information Copy from Customer Info
    Shipping Method
    Standard ($7.50)
    Express ($15.00)
    Pick Up at Headquarters (FREE)
    Pick Up at Authorized Agent (FREE)
    ATTN / Company Name
    Street Address
    Address 2
    City
    		 State
          		 Postal Code
    Country 
    Date leaving shipping address:
    Other Information:
    Promo Code:
    How did you hear about us?
    Special Instructions:
    By clicking submit, applicant agrees to the Terms and Conditions (click here to read) and understands that credit card will be authorized for the security deposit.
     




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