Letter of Authorization to Change Voice and Data Carrier

The undersigned customer wishes to switch its current voice and data carrier to Blackfoot Communications (“Blackfoot”). Blackfoot is hereby designated to act as its agent for the purpose of:

notifying customer’s local telephone company of the selection of Blackfoot as primary carrier,
effectuating a port of any telephone numbers provided below, and
ordering, in connection with Blackfoot provision of service, changes in and/or maintenance on specific telecommunications and/or data service including, without limitation, adding to rearranging such service.

Selection of Blackfoot will apply to the billing account or telephone number(s) listed below. The undersigned customer understands that they are designating Blackfoot as their primary carrier.

Unless otherwise agreed to in writing, Blackfoot shall have no obligation or responsibility to arrange for termination or removal of services provided by other carriers.

The undersigned customer shall remain responsible for terminating/removing any such unwanted services and circuits provided by other carriers.

Please select all that apply.(Required)

Voice

Long distance

Data

For my 10-digit phone numbe(s) or account number(s) listed below.*(Required)

One phone phone number or account number per line please.

Authorized account holder name(Required)

First Last

Authorized account holder phone number(Required)

Authorized account holder email address(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

By selecting "Yes" below, you are authorizing the changes in the above form.(Required)

Yes

Selecting “Yes” acts as your signature.

Please enter today's date.(Required)

Order Service

Letter of Authorization to Change Voice and Data Carrier