CUSTOMER INFORMATION



Yes! I want to choose TruComm and sign up for TruComm's Complete Phone Service. I authorize TruComm to act as my agent for my telephone services and to switch my telephone services listed below from my current carrier(s) to TruComm for my local and/or long distance carrier(s). I understand that only one carrier may be presubscribed for any one telephone number for each of the telephone services listed. I also understand that a fee may be charged for switching service and that I may consult with TruComm as to whether a fee will apply.

Residential Phone Service
Super Savings Plan
Unlimited Local A|B Plan
Unlimited Local A|B|C Plan

Business Phone Service
Plan 14.00     Plan 32.00

Internet and Broadband Service
Dial Up     DSL

Email
Computer and Network repair/support

New Phone Service
Convert My Phone Service   Phone Number:

I certify that I have read and understand this Letter of Agency, that I am at least eighteen years of age, and that I am authorized to change carriers for the designated services for the listed telephone numbers. I also confirm that the information on this form is correct.

NO SERVICE IS ACTIVATED UNLESS CONFIRMED BY TRUCOMM. TRUCOMM WILL NOTIFY YOU BY PHONE UPON ACTIVATION OF SELECTED SERVICES.

Name:
Contact Number:
Address:
City:
State:
Zip Code:
Email:

Note (optional):