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Winack LOA - CenturyLink

By Hazel Perkins,2014-12-26 04:15
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Winack LOA - CenturyLinkWinack

    LETTER OF AGENCY

     (All Sections must be completed. If a section does not apply, please indicate by using “NA.”)

Name of Person Authorized to Act on Behalf of the Company Contact Telephone Number

     (MUST BE THE SAME PERSON WHO SIGNS THIS FORM)

     —————— Billing Address of Main Telephone Number ——————

    Company Attention

    Street

    City State Zip

    ———— Service Address (if different than Billing Address) ————

    Company Attention

    Street

    City State Zip

    —————————— Verification Information ——————————

    Date of Birth or SSN (last 4 digits) or Federal EID #

TELEPHONE LINES

    ; List Main Telephone Number (BTN) as it appears on the local bill and the associated telephone numbers.

    ; Select the appropriate box(es) next to each telephone number for which you want CenturyLink service.

    Main Telephone Number Long Distance Local Toll Local Service

     - -

    —————————— Associated Telephone Numbers ——————————

    Telephone Long Local Local Telephone Long Local Local

    Number Distance Toll Service Number Distance Toll Service

     - - - -

     - - - -

     - - - -

     - - - -

     - - - -

     Please check if a separate page listing other associated telephone numbers is attached

    IMPORTANT CUSTOMER AUTHORIZATION

    By signing below:

    I AUTHORIZE CENTURYLINK COMMUNICATIONS* TO BECOME THE NEW BUSINESS PHONE SERVICE PROVIDER for some or all of the following services selected in this Letter of

    Agency for the telephone number(s) listed above: (1) long-distance service long distance calls within my company’s state, from my company’s state to another state and international calling;

    (2) local toll service calls to locations just outside my company’s local calling area; and/or (3)

    local service CenturyLink** for calls within my company’s local calling area. I also authorize

    and designate CenturyLink to act as my company’s agent to make this change happen, and direct my company’s current local service provider for my business phone to work with

    CenturyLink to make these changes.

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    LETTER OF AGENCY

    I UNDERSTAND THAT: (1) I may consult with my company’s current local service provider to determine if any fees apply when I switch my business phone service to CenturyLink or if I later decide to switch back my company’s service; (2) this change request only applies to the telephone number(s) on this request; (3) I may select only one presubscribed long distance, one presubscribed local toll and one presubscribed local service provider for each telephone number; (4) CenturyLink may have different calling areas, rates and charges for each of the services selected by me than my company’s business phone service provider(s) and that I will be billed

    accordingly; (5) state-to-state and international long distance rates and services from CenturyLink are governed by the CenturyLink Standard Terms and Conditions for Communications Services; and (6) local and instate long distance including local toll rates and

    services are governed either by applicable state tariffs on file with my state’s regulatory commission or by the CenturyLink Standard Terms and Conditions for Communications Services.

    Texas, Illinois, Massachusetts, New York, Washington and West Virginia Residents Only: Individual authorized to act for customer (if applicable, e.g. spouse, legal guardian):

First Name Last Name

    Relationship

    Telephone # of individual authorized to act for customer

    AUTHORIZED by the undersigned on the date indicated below:

     Date

    Individual Authorized to Act for Customer

Vermont Residents Only:

    You have the right to file a complaint with the Consumer Affairs Division of the Department of Public Service at 112 State Street, Drawer 20, Montpelier, VT 05620-2601, 1-800-622-4496, 1-800-734-8390 (TTY).

Indiana Residents Only:

    You have the right to file a complaint with the Consumer Affairs Division of the Indiana Commission. Write to: Consumer Affairs Division Indiana Utility Regulatory Commission

    Indiana Government Center South - 302 West Washington St Room E306 Indianapolis,

    Indiana 46204. Call 1-800-851-4268 toll free within Indiana only, 317-232-2700 local Indianapolis, 317-232-8556 TDD or 317-233-2410 FAX. Office Hours 0800 to 1700.

    I HAVE READ AND UNDERSTAND THIS LETTER OF AGENCY. I’M AT LEAST 18 YEARS OLD AND AUTHORIZED TO CHANGE THE SERVICE PROVIDER FOR THE SELECTED

    SERVICE(S) AND TELEPHONE NUMBER(S). I UNDERSTAND THAT MY COMPANY’S

    CURRENT LOCAL SERVICE PROVIDER MAY CHARGE A FEE FOR EACH PROVIDER

    CHANGE.

    BY DATE

     AUTHORIZED SIGNATURE

    SIGNING THIS DOCUMENT WILL RESULT IN A PROVIDER CHANGE.

    *CenturyLink Communications of Virginia is the service provider in the Commonwealth of Virginia. **CenturyLink Pennsylvania is the local service provider in the state of Pennsylvania.

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    PREFERRED INTEREXCHANGE CARRIER (PIC) FREEZE

    A PIC Freeze protects your company’s selection of Embarq Communications, Inc.* as its new provider of long distance service and/or local toll service. A PIC Freeze protects your company from an unauthorized switch to another long distance provider without your permission. Your long distance selection cannot be changed to another long distance carrier until your company removes the PIC Freeze with CenturyLink Communications.* The service is FREE and can be lifted at any time by simply calling an CenturyLink Communications representative.

     Name of Person Authorized to Act on Behalf of the Company Contact Telephone Number

     (MUST BE THE SAME PERSON WHO SIGNS THIS FORM)

     —————— Billing Address of Main Telephone Number ——————

    Company Attention

    Street

    City State Zip

    ———— Service Address (if different than Billing Address) ————

    Company Attention

    Street

    City State Zip

    —————————— Verification Information ——————————

    Date of Birth or SSN (last 4 digits) or Federal EID #

TELEPHONE LINES

    ; List Main Telephone Number (BTN) as it appears on the local bill and the associated telephone numbers. ; Select the appropriate box(es) next to each telephone number for which you want a PIC Freeze to CenturyLink

    Communications.*

    Main Telephone Number Long Distance Local Toll

     - -

    —————————— Associated Telephone Numbers ——————————

    Telephone Number Long Distance Local Toll Telephone Number Long Distance Local Toll

     - - - -

     - - - -

     - - - -

     - - - -

     - - - -

     Please check if a separate page listing other associated telephone numbers is attached

    I HAVE READ AND UNDERSTAND THIS PREFERRED INTEREXCHANGE CARRIER

    FREEZE FORM. I’M AT LEAST 18 YEARS OLD AND AUTHORIZED TO FREEZE THE SERVICE PROVIDER FOR THE SELECTED SERVICE(S) AND TELEPHONE NUMBER(S).

    BY DATE

     AUTHORIZED SIGNATURE

    *CenturyLink Communications of Virginia is the service provider in the Commonwealth of Virginia.

    Page 3 of 3 V090102

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