Letter of Authorization

Letter of Authorization

To Whom it May Concern:

I hereby select Packerland Broadband (PLTC) to be my local exchange provider and to act as our Agent in dealings with our current local exchange telephone company. In this regard, PLTC may place orders for new services, changes to existing services, as well as request and receive the results of busy/traffic studies.

This authorization covers the following locations and primary billing telephone numbers and shall remain in effect until further written notice is provided. I understand that I can have only one local service provider for any one telphone number.

Account number with your current phone provider: A value is required.

Century Link PIN:

Name as it appears on your current phone bill: A value is required.

Service or physical address
Street: A value is required.
City: A value is required.
State: A value is required.
Zip Code: A value is required.

If different, your billing address (IE, PO BOX)
Zip Code:

I am authorizing PLTC to become my new telephone service provider in place of A value is required. (current provider) for the provision of local telephone services. I authorize PLTC to act as my agent to make this change happen, and direct my current provider to work with PLTC to effect this requested change.

I understand that if I wish to return to my current local telephone company, I may be required to pay a reconnection charge to that company. I also understand that my new local telephone company may have different rates and charges than my current telephone company, and that by signing below I indicate that I understand thosee differences and am willing to be billed accordingly.

I authorize PLTC to provide local service to my telephone number(s) listed below, and no others.

Number to be ported: A value is required.

This is what the person you are calling will see on their caller ID (up to 15 digits, spaces included): A value is required.

I certify that I have read and understand this Letter of Authorization. I further certify that I am at least eighteen years of age, and that I am authorized to change telephone companies for services to the telephone numbers listed above.

I also authorize PLTC to act as my agent to notify my local phone company of my decision to change my current long distance service to PLTCs service. I understand that my local phone company may charge me a fee to switch long distance carriers. Selection of PLTC will apply to the telephone number(s) listed on this form. I, the customer, understand that I may designate only one interexchange carrier for any one telephone number for interLATA and, where applicable, intraLATA usage, and hereby designate PLTC as my primary carrier.

By entering my name below I represent that I am the authorized signer on the account listed and agree to the terms and conditions referenced above.

Signature: A value is required.

Title: A value is required.

Packerland account number or last four digits of your Social Security Number: A value is required.



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