| Name: | Email Address: | ||
Check One:
___ New Account
___ Existing Account |
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| SS# (required for credit check purposes only): | |||
| Street Address: ______________________________________________
(CANNOT USE P.O. BOX, MUST BE A STREET ADDRESS)
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| City: | State: | Zip: | |
| Contact Phone# (required): | Estimated Monthly Usage: | ||
| Check Here to Order ULTRAcard™ Calling Card | |||
| Number of cards desired: ____ | |||
| Check Here to Order ULTRAcall™ Toll-Free | |||
| Direct my new Toll-Free Number to ring into the following #:(Required) (_____) ___________________ |
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| TO TRANSFER AN EXISTING TOLL-FREE NUMBER, PLEASE CHECK HERE* ___
Existing Toll-Free #: (_____) ___________________ Current carrier: ___________________ |
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| *NOTE: Additional paperwork will be mailed to you to complete the transfer of your existing 800/888#. Once it is returned to ATN, we will complete the transfer for you. | |||
| Check Here to Order ULTRAcall 1+™ Long Distance | |||
| Please switch my following number: (_____) ___________________ | |||
| Any additional home number(s) to be switched: (_____) ___________________ (____) ________________ IF YOU DO NOT WANT YOUR CARRIER CHANGED FOR LOCAL AREA TOLL CALLS (INTRALATA), PLEASE CHECK HERE: ____ |
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| By signing below, I am authorizing TTI National, Inc. (TTI) to become my new long distance provider, in place of my current provider named above, for the provision of the services I have designated on this service agreement. I authorize TTI to act as my legal agent to make changes requested, and direct my current provider to work with TTI to affect the change. I understand that I must pay a charge of approximately $5.00 per line to switch providers. TTI will issue a credit (not to exceed $5.00 per line) upon my request. If I later wish to choose another long distance carrier, I may be required to pay another switching fee. I also understand that TTI may have calling areas, rates and charges that differ from my current long distance carrier. By signing below, I am indicating that I understand those differences (if any) and am willing to be billed accordingly. I authorize TTI to provide the services I have requested and no others. I understand that only one carrier may be designated as my interlata primary interexchange carrier (regular long distance) for a given telephone number. If my state allows me to choose a carrier for interlata toll calls (also known as local long distance calling), or allows me to choose a carrier for local calls, I understand that I may designate different carriers for each. If I have ordered ULTRAcall 1+ long distance service, I have indicated whether or not I have chosen TTI to also provide intralata (local long distance service. |
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| Service is provided pursuant to the applicable TTI tariff which may be amended from time to time and is made part of this application. I further understand that this offer is subject to credit approval, and certify that the information on this application is correct to the best of my knowledge. I accept responsibility for payment of all charges incurred. | |||
| Signature: X | Date: | ||
| Check here to receive information on our cost-cutting business plans. | |||
| Check here to receive dealer information. | |||
| Check here to receive information on our internet service | |||
For fastest service FAX (in FINE MODE) to 1 (800) 700-4387, 24 hours a day. We'll do the rest. Mailing Instructions: Please complete all requested information, sign, and mail to: AMERICAN TELECOM NETWORK 10211 N 32ND ST STE A5 PHOENIX AZ 85028-9826 |