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AUTOMATIC LEASE PAYMENT PLAN

Just follow these three easy steps:

1. Complete this application and be sure to sign it.

2. If selecting the checking account payment option, please enclose an unsigned personal check marked “VOID.”

3. Mail your completed application today to:

QLT Consumer Lease Services
P.O. Box 26043
Miami, FL 33102-9551

Please do not mail back with your payment. You may cancel your participation at any time by providing written notice to QLT Consumer Lease Services at the above address.

• Once your Automatic Lease Payment Plan Application is received and processed, we’ll notify you that you have been enrolled in the plan.
• Your checking or credit card account will be debited automatically not more than 9 days prior to the usual payment due dates for your account. For information about payment due dates, or answers to any questions, call our Lease Customer Helpline at 1 (800) 555-8111.
• We will send you an annual notice describing each item of leased telephone equipment on your account with its associated charges and annual lease service contract.

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