...a telephone reminder service
to help you remember those special dates

APPLICATION (Please Print)
Name:_______________________________________________
Address:_____________________________________________
City:_____________________State:_____Zip Code:_________
Home Phone:______________Work Phone:_________________
Payment Method: žCheck/Money Order žVISA* žMaster Card*
 
Make checks or money orders payable to Tele-Touch for $49.99 and send
with application to 250 Marcus Blvd., PO Box 18045, Hauppauge, NY 11788-8845
If using charge call the information into (516) 234-4499.
*For your protection Do not use the internet or the fax for your charge account information.


Tele-Touch Reminder List
Please list all personal and/or business occasions
you would like to be reminded of:
OCCASIONOCCASION
Date		OCCASION
is for...		OCCASION
Location		CALL ME
Home/Work		Leave
A Message
Yes/No*		CALL ME
No Later
Than
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       

*If you check NO message should be left, Tele-Touch provides a 3 attempt limit when trying to contact you directly.

If you do not specify a CALL ME NO LATER THAN date, Tele-touch will automatically call you 2-3 days prior to the OCCASION DATE -- at the number you specify

Print out, Fill-in, then Fax to 516-232-1065
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