1770 Indian Trail Road.
Suite 200 Local/Long Distance Service Agreement
Norcross, Georgia 30093 Vermont
Phone: 404-921-0388
Fax: 404-506-9538
1. Customer Information
First Name ( Name must be as it appears on phone bill) M.I. Contact Number (Required)
Last Name Billing Telephone Number
*(Write "New" if requesting a new number)
Service Address Social Security Number (Required)
VT
City State Zip Email Address
2. Billing Information (if different than above)
Address_________________________________________City_________________________________State_______ Zip________________
3. Bundled Local/Long Distance Products
Plan Names | Local | | Bundled |
Please note that
All Zones MRC | 39.95/Month ❏ | proper wiring and | 54.95/Month ❏ |
Carrier Code | 5102 | phone jacks are | 5102 |
Local Calling Minutes | Unlimited | required for this | Unlimited |
IntraLata Rate | 5.2 Cents/Min | service. If Inside | Unlimited |
IntraState Rate | 5.2 Cents/Min | wiring is | Unlimited |
necessary then
State-to State Rate | 3.9 Cents/Min | | Unlimited |
additional charges
Free Long Distance | 0 | will apply. | Unlimited |
Install Fee (new lines only) | 65.00 | | 65.00 |
FREE SERVICES
Caller ID Name Display | Included | | Included |
Call Waiting w/Caller ID | Included | | Included |
Call Forwarding | Included | | Included |
Three Way Calling | Included | | Included |
Travel Cards ❏ Yes I would like travel cards Quantity:
Card#1 PIN: Card#2 PIN: Card#3 PIN:
ADDITIONAL SERVICES
Voice Mail | 6.95/Month ❏ | | 6.95/Month ❏ |
Inside Wire Maintenance | 5.95/Month❏ | | 5.95/Month ❏ |
Auto Redial | 2.50/Month ❏ | | 2.50/Month ❏ |
Speed Calling 8 | 1.25/Month ❏ | | 1.25/Month ❏ |
Call Screening | 2.50/Month ❏ | | 2.50/Month ❏ |
Auto Call Back (*69) | 2.50/Month ❏ | | 2.50/Month ❏ |
Distinctive Ring 1 | 2.50/Month ❏ | | 2.50/Month ❏ |
Distinctive Ring 2 | 2.50/Month ❏ | | 2.50/Month ❏ |
Non-Listed Number | 1.75/Month ❏ | | 1.75/Month ❏ |
Non Published Number | 4.95/Month ❏ | | 4.95/Month ❏ |
4. 1 Voice Customer Authorization (Services provided by ComTech21 DBA Prescient Worldwide)
TO: All Local Exchange Companies (LECs), Long Distance Companies (IXCs), Resellers, Rebillers, and Regional Bell Operating Companies (RBOCs). In accordance with this executed agreement, I/We (“Customer”) do hereby authorize
1Voice Worldwide (services provided by ComTech21) to act as our communications agent to place service orders, change network carriers, obtain telephone account information/numbers, PIC codes, and any other customer information
needed to assign 1Voice Worldwide (services provided by ComTech21) agency to vendors and authorizing them to implement contracted services for local, data, wireless, IP, interstate, intrastate, intralata and/or international long distance
services (“Services”). Customer understands that state to state rates may differ from intrastate rates, intralata toll and international rates. Domestic rates are billed on a six (6) second increments. International rates are billed on a thirty (30)
second initial increments and six (6) seconds thereafter. Calls to Mexico are billed in full minute increments. Travel Card services are billed in full
minute initial increments and six (6) seconds thereafter. Unlimited long distance and/or free minutes apply to domestic 1+ calls only. Customer’s bill also includes various taxes, monthly fees and surcharges authorized by federal, local and
state governments which may exceed $10 per month per line. Service is designed for residential voice usage only. Excessive call volume or excessive or unusual usage may result in additional charges or interruption of Services. Service
availability is subject to customer meeting credit criteria. Customer provides authorization to perform credit checks and investigate customer's bank and other credit references, where permitted by law. By executing this Service Agreement
Customer agrees to the additional terms and conditions set forth at http://securedcontent.net/1voiceww/screpaccess_terms_and_conditions.html. If you are unable to access this link please contact us at 404-921-0388 to request a copy of
these additional terms and conditions. I warrant that I have the legal authority to bind the undersigned to this agreement and that I am free of any third-party obligation preventing me from authorizing ComTech21 and/or its authorized agents
to act as my agent.
_________ My initial's here confirm that I understand if DSL is currently on my existing line (which is being moved to 1Voice) I will no longer
have DSL, and all features not noted on this form will no longer be available unless selected.
Authorized Signature____________________________________________________________________ Date_______________
Printed Name____________________________________________________________________________ Rev 5/18/07
Rep Name Printed Rep Signature Rep I.D.
