| Billing Name of Subscriber (as appears
on phone bill):_______________________________________________ |
| My Name (if Different): _____________________________
Relation to the subscriber_____________________ |
Phone Number(s) covered by this Letter of
Agency: _________________________________________________
__________________________________________________________________________________________
|
| Billing Address: Street: __________________________________________________Apt
No. _______________ |
| City: __________________________ |
State:__________ |
Zip Code:_______________________________ |
| By my signature below, I designate
ANC to act as my agent for the purpose of making each of the
preferred carrier changes that I have specified below (by placing
an "x" in the box preceding the requested preferred carrier
change), and authorize ANC to inform my existing local exchange
carrier of the change(s). I certify that I am of legal age
and that I have proper authority to sign this Letter of Agency. |
[ ] I designate ANC as
my preferred
local exchange carrier.
|
| [ ] I designate ANC as
my preferred interexchange carrier for interstate
and interLATA toll calls. I understand
that only one telecommunications carrier may be designated
as a subscriber's preferred interexchange carrier
for interstate or interLATA toll calls for any one telephone
number. |
| [ ] I designate ANC as my preferred
interexchange carrier for intraLATA toll calls. I understand
that only one telecommunications carrier may be designated
as a subscriber's preferred interexchange carrier for intraLATA
toll calls for any one telephone number. |
| [ ] I designate ANC as
my preferred interexchange carrier for international
toll calls. I understand
that only one telecommunications carrier may be designated
as a subscriber's preferred interexchange carrier for international
toll calls for any one telephone number. |
| I understand that my existing local
exchange carrier may assess a fee for each change of preferred
carrier that I request. |
_____________________________________________
Authorized Signature |
______________________________
Date |
