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Text File  |  1993-09-01  |  2KB  |  69 lines
  1. (HIT THE 'P' KEY TO PRINT)
  2. 800# SERVICE REQUEST FORM
  3.  
  4. A.F.I. LONG DISTANCE SERVICE - SERVICE REQUEST AGREEMENT
  5.  
  6. _____________________________________________________________________________
  7. NAME>                            CONTACT>                 TITLE>
  8. STREET ADD>                                          COUNTY>
  9. CITY>                                                 STATE>       ZIP>
  10. BILLING ADDRESS, IF DIFERENT FROM ABOVE>
  11.  
  12. CONTACT>
  13. PHONE>                                BUSINESS OR PERSONAL?>    
  14. BUSINESS BANK>                BRANCH>               ACCT NO>
  15.  
  16. TRADE REFERENCE1>                       CONTACT>          PHONE>
  17. TRADE REFERENCE2>                       CONTACT>          PHONE>
  18. PRESENT CARRIER>               EST. MONTLY LONG DISTANCE BILL>
  19. FED. TAX ID>
  20.  
  21. _____________________________________________________________________________
  22. 800 SERVICE INFORMATION:
  23.  
  24. HOW MANY 800 NUMBERS>     MAIN BILLING TELEPHONE NO.>
  25.  
  26.     LIST BELOW ALL 800 PHONE NUMBERS.  
  27.  
  28.   AREA CODE   NUMBER             
  29. 1.   800   -                  
  30.   AREA CODE   NUMBER          
  31. 2.   800   -        
  32.   AREA CODE   NUMBER           
  33. 3.   800   -            
  34.   AREA CODE   NUMBER           
  35. 4.   800   -   
  36.   AREA CODE   NUMBER           
  37.  
  38. DO YOU WANT TO BE LISTED IN DIRECTORY ASSISTANCE?> 
  39. WHAT NUMBER WILL 800 RING IN ON?>
  40. INTERNATIONAL 800?  YES>      NO>
  41. AREA CODES OR STATES TO BE EXCLUDED IF ANY>
  42. CANADIAN 800?       YES>      NO>
  43. LISTING NAME PREFERRED>
  44. ____________________________________________________________________________
  45.                              
  46. I hereby authorize Affinity Fund, Inc. or their authorized representative to
  47. transfer my long distance line carrier.  I understand that my local operating
  48. company may charge a fee to perform the transfer.  I accept responsibility for
  49. all changes associated with the above telephone number.
  50.  
  51.  
  52. _____________________________________________________________________________
  53. AUTHORIZED SIGNATURE                      TITLE               DATE                                              
  54.  
  55. _____________________________________________________________________________
  56. PRINT NAME
  57.  
  58. _____________________________________________________________________________
  59. ANI CONSULTANT SIGNATURE
  60. CONSULTANT ID CODE:  747-0180
  61.  
  62.  
  63. SEND COMPLETED REQUEST FORM TO:
  64. OR FAX TO:
  65. (408) 423-0131
  66. LIGHTHOUSE PRODUCTIONS
  67. P.O. BOX 7885
  68. SANTA CRUZ, CA 95060
  69.