Satellite Messaging Tracking Services

Stratos Scratch & Phone Card Form Request

Please Complete the following questions:
Fields marked with an asterisk * are required.

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Customer Details

Company Name:*

Address:*

Town/City:

State/Province:

Post/Zip Code:*

Country:

Contact Person:*

Telephone*

+ Country code: Area code: Telephone number:*

Facsmile

+ Country code: Area code: Facsimile number:

Email Address:*

Vessel Details

Ship Name:*

Call Sign:*

Excel Password Encryption:
(Virtual Cards)*

(max. 12 alphanumeric characters)

Types of Scratch & Phone Cards Order

Card Type:

Physical Virtual

Quantity

Fleet 77, Mini-M & Inmarsat B

25 Mins

75 Mins

Authorization (Please stamp and sign to confirm your order)

Ship Owner/ Ship Manager/ Agent Company

Date:*

Designation:*

_____________________

Name:*

Signature/Company Stamp

Mandatory Fields

For Official Use Only

Date:

_____________________

(Card Issued) Name:

Signature/Company Stamp

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Please complete this form and send it by fax/ email to us at +65 6224 5581/ info@smtspl.com. You will receive a notification once the registration has been completed. Please do not hesitate to contact us if you need any further information.