home *** CD-ROM | disk | FTP | other *** search
/ Current Shareware 1994 January / SHAR194.ISO / articles / invent01.zip / RESIDENT.TXT < prev    next >
Text File  |  1993-08-24  |  2KB  |  67 lines
  1.                   RESIDENTIAL SERVICE REQUEST FORM
  2.         A.F.I. LONG DISTANCE SERVICE - SERVICE REQUEST AGREEMENT
  3. _________________________________________________________________________
  4.  
  5. NAME>                            
  6. ______________________________________________________________________
  7.         EXACTLY AS IT APPEARS UNDER CURRENT BILLING
  8. SOC. SEC. #>
  9. ________________________________________________
  10.  
  11. ACTUAL STREET ADDRESS [NO P.O. BOX]> 
  12. CITY>                                               STATE>       ZIP>
  13. COUNTY>
  14. BILLING ADDRESS, IF DIFERENT FROM ABOVE>
  15.  
  16. __________________________________________________________________________
  17. SERVICE INFORMATION:
  18.  
  19. ENTER EACH TELEPHONE NUMBER INCLUDING AREA CODE.  TOP NUMBER SHOULD BE
  20. YOUR BILLING NUMBER.  LIST ADDITIONAL NUMBERS ON SEPARATE SHEET IF 
  21. NECESSARY.
  22.  
  23. AREA CODE>           NUMBER>
  24. AREA CODE>           NUMBER>
  25. AREA CODE>           NUMBER>
  26. AREA CODE>           NUMBER>
  27.  
  28. [THE FOLLOWING IS NECESSARY TO INSURE YOUR DISCOUNT]
  29.  
  30. _____________________________________________________
  31. PRESENT LONG DISTANCE CARRIER
  32.  
  33. _____________________________________________________
  34. CURRENT DISCOUNT CALLING PLAN
  35.  
  36. I WOULD LIKE TO ORDER _____  TRAVEL CARDS.
  37.  
  38.       
  39. SERVICE AUTHORIZATION
  40. _________________________________________________________________________
  41.  
  42. With this signature I authorize Affinity Fund to change my long distance
  43. carrier for the telephone number(S) indicated.  I authorize Affinity Fund 
  44. to notify my local telephone company of this choice.  I understand that I 
  45. can have onliy one primary long distance company for a given telephone
  46. number and that my local telephone company may impose a charge for this 
  47. and any later change.
  48.  
  49. ________________________________________________________________________
  50. SIGNATURE                                            DATE
  51.  
  52.  
  53.  
  54. ____________________________________________________________________
  55. PRINT NAME
  56.  
  57. SEND COMPLETED REQUEST FORM TO:
  58. OR FAX TO:
  59. (408) 423-0131
  60. LIGHTHOUSE PRODUCTIONS
  61. P.O. BOX 7885
  62. SANTA CRUZ, CA 95060
  63.  
  64. CONSULTANT ID CODE: 747-0180
  65.  
  66.  
  67.