800# SERVICE REQUEST FORM A.F.I. LONG DISTANCE SERVICE - SERVICE REQUEST AGREEMENT _____________________________________________________________________________ NAME> CONTACT> TITLE> STREET ADD> COUNTY> CITY> STATE> ZIP> BILLING ADDRESS, IF DIFERENT FROM ABOVE> CONTACT> PHONE> BUSINESS OR PERSONAL?> BUSINESS BANK> BRANCH> ACCT NO> TRADE REFERENCE1> CONTACT> PHONE> TRADE REFERENCE2> CONTACT> PHONE> PRESENT CARRIER> EST. MONTLY LONG DISTANCE BILL> FED. TAX ID> _____________________________________________________________________________ 800 SERVICE INFORMATION: HOW MANY 800 NUMBERS> MAIN BILLING TELEPHONE NO.> LIST BELOW ALL 800 PHONE NUMBERS. AREA CODE NUMBER 1. 800 - AREA CODE NUMBER 2. 800 - AREA CODE NUMBER 3. 800 - AREA CODE NUMBER 4. 800 - AREA CODE NUMBER DO YOU WANT TO BE LISTED IN DIRECTORY ASSISTANCE?> WHAT NUMBER WILL 800 RING IN ON?> INTERNATIONAL 800? YES> NO> AREA CODES OR STATES TO BE EXCLUDED IF ANY> CANADIAN 800? YES> NO> LISTING NAME PREFERRED> ____________________________________________________________________________ I hereby authorize Affinity Fund, Inc. or their authorized representative to transfer my long distance line carrier. I understand that my local operating company may charge a fee to perform the transfer. I accept responsibility for all changes associated with the above telephone number. _____________________________________________________________________________ AUTHORIZED SIGNATURE TITLE DATE _____________________________________________________________________________ PRINT NAME _____________________________________________________________________________ ANI CONSULTANT SIGNATURE CONSULTANT ID CODE: 747-0180 SEND COMPLETED REQUEST FORM TO: OR FAX TO: (408) 423-0131 LIGHTHOUSE PRODUCTIONS P.O. BOX 7885 SANTA CRUZ, CA 95060