Long Distance Carrier Change Form

LONG DISTANCE CARRIER CHANGE

(Failure to complete ALL sections completely could delay the processing of your order)

* Required

Account Information
*	Name:
*	Account Number or Phone Number:
*	Daytime Contact Phone Number:
Email Address:

Carrier Change Fees:

One-time fee per carrier change as indicated below. There are no additional service order charges or monthly fees.

Inter-Carrier -	1st change after initial installation - Free All other changes - $5.50 one-time charge
Intra-Carrier -	$5.00 for changing anytime
Combo Pic Discount -	$7.75
Restricted Pick* -	No Charge

Long Distance Carrier Selections:

If you have already signed up for Restricted Pick for Long Distance Carrier and have previously entered a password question and answer into our system, then please enter your password and question below. Otherwise, a representative from our office will contact you to confirm your request to change your long distance carrier.

Choose Question:
Your Answer to this Question:

Please indicate your preferred long distance carrier. A carrier MUST be selected for each type of Lata. For a detailed explanation of InterLata and IntraLata, please check the white page information section in the front of your local phone book or Click Here: InterLata and IntraLata Info

* InterLata Carrier:
* IntraLata Carrier:

Add Restricted PIC for Long Distance Carrier (RPIC):

A free option that prevents your long distance carrier choice from being changed unless you either call the business office and request a change, or fill out the on-line form providing the correct password for this action.

* Do you want to add RPIC? Yes: No:

If Yes, Please Enter a password based on one of the following questions:

Choose Question:
Your Answer to this Question:

Comments: