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Text File  |  1993-10-10  |  5KB  |  52 lines
  1.                                    BUSINESS or PERSONAL SERVICE REQUEST FORM
  2.  
  3.  
  4. CO. NAME>                                                               CONTACT>                                                                TITLE>
  5. STREET ADD>                                                                        COUNTY>
  6. CITY>                                                                                                                     STATE>                                       ZIP>
  7. BILLING ADDRESS, IF DIFERENT FROM ABOVE>
  8.  
  9. BUSINESS BANK>                                                                                   BRANCH>                                                                     
  10. ACCT NO>                                                                   CONTACT>                                               PHONE>                                  
  11. BUSINESS OR PERSONAL?>  
  12. TRADE REFERENCE1>                                                                        CONTACT>                                                                                   PHONE>
  13. TRADE REFERENCE2>                                                                        CONTACT>                                                                                   PHONE>
  14. PRESENT CARRIER>                                                                            EST. MONTLY LONG DISTANCE BILL>
  15. FED. TAX ID>
  16.                                                                                         SERVICE INFORMATION:
  17.  
  18.  HOW MANY NUMBERS>                             LIST BELOW ALL PHONE NUMBERS.  IDENTIFY WHICH LINES
  19.  ARE BILLING TELEPHONE NUMBERS (BTN) NOTE:  YOU MAY HAVE MORE THAN ONE BTN.             ALSO SPECIFY LINE TYPE 
  20.  PER CODE:   F= FAX,  M= MODEM,  V= VOICE.
  21.  
  22. AREA CODE                NUMBER           BTN TYPE                                AREA CODE            NUMBER           BTN  TYPE
  23.   1.                         -                                                                                                      5.                    -   
  24. AREA CODE                NUMBER           BTN  TYPE                               AREA CODE            NUMBER           BTN  TYPE
  25.   2.                         -                                                                                                       6.                    -   
  26.  AREA CODE              NUMBER           BTN  TYPE                                 AREA CODE            NUMBER           BTN  TYPE                   
  27. 3.                           -                                                                                                       7.                     -   
  28.   AREA CODE             NUMBER           BTN  TYPE                                 AREA CODE            NUMBER           BTN  TYPE
  29. 4.                           -                                                                                                       8.                      -                   
  30. ______________________________________________________________________________________________________________
  31. 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.
  32.  
  33. ____________________________________________________________________________
  34. AUTHORIZED SIGNATURE                      TITLE               DATE                                              
  35.  
  36. _____________________________________________________________________________
  37. PRINT NAME
  38.  
  39. _____________________________________________________________________________
  40.  
  41.  
  42.  
  43. SEND COMPLETED REQUEST FORM TO:                                                                   OR FAX TO:  (408) 423-0131
  44. LIGHTHOUSE PRODUCTIONS
  45. P.O. BOX 7885
  46. SANTA CRUZ, CA 95061
  47.  
  48. ______________________________________________________________________________________________________________
  49. OFFICE USE ONLY       ANI CONSULTANT SIGNATURE              CONSULTANT ID CODE:  747-0180
  50.  
  51. Remember, this Long Distance calling Plan is GUARANTEED to save you at least 10% of your monthly Long Distance Bill.  If you can show that AFI did not save you at least 10% of your first month's Long Distance Charges with us, send us the bill and you will be paid your ENTIRE MONTHLY LONG DISTANCE CHARGES.  That's a guarantee that means something.  
  52.