1 Voice
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Local/Long Distance Service Agreement Arizona Phone: 404-921-0388 Fax: 404-506-9538
1770 Indian Trail Road. Suite 200 Norcross, Georgia 30093
1. Customer Information
First Name
( Name must be as it appears on phone bill)
M.I.
Last Name
Contact Number
(Required)
Billing Telephone Number *(Write "New" if requesting a new number)
Service Address
Social Security Number
(Required)
AZ City
State
Zip
Email Address
2. Billing Information (if different than above) Address_________________________________________City_________________________________State_______ Zip________________ 3. Bundled Local/Long Distance Products Plan Names Zone1 MRC Zone2 MRC Zone3 MRC Carrier Code Local Calling Minutes IntraLata Rate IntraState Rate State-to State Rate Free Long Distance Install Fee (new lines only) Caller ID Name Display Call Waiting w/Caller ID Call Forwarding Three Way Calling
| | | | | | | | | | | | | | |
❏ 31.99/Month ❏ 57.99/Month ❏ 0432 Unlimited 8.7 Cents/Min 8.7 Cents/Min 3.9 Cents/Min 0 65.00 Included Included Included Included ❏ Yes I would like travel cards
Travel Cards
Card#1 PIN: Voice Mail Inside Wire Maintenance Auto Redial Speed Calling 8 Call Screening Auto Call Back (*69) Distinctive Ring 1 Distinctive Ring 2 Non-Listed Number Non Published Number
| | Please note that proper wiring | and phone jacks | are required for | this service. If | Inside wiring is | necessary then | additional | charges will | apply. | FREE SERVICES | | | |
Local 25.99/Month
| | | | | | | | | |
❏ ❏ 2.50/Month ❏ 1.25/Month ❏ 2.50/Month ❏ 2.50/Month ❏ 2.50/Month ❏ 2.50/Month ❏ 1.75/Month ❏ 4.95/Month ❏ 6.95/Month
5.95/Month
| | | | | | | | | | | | | | |
| | | | | | | | | | |
Bundled
❏ 51.99/Month ❏ 77.99/Month ❏ 45.99/Month
0432 Unlimited Unlimited Unlimited Unlimited Unlimited 65.00
| | | |
Included Included Included Included
Quantity: Card#2 PIN:
ADDITIONAL SERVICES | | | | | | | | | |
Card#3 PIN:
| | | | | | | | | |
❏ ❏ 2.50/Month ❏ 1.25/Month ❏ 2.50/Month ❏ 2.50/Month ❏ 2.50/Month ❏ 2.50/Month ❏ 1.75/Month ❏ 4.95/Month ❏
| | | | | | | | | |
6.95/Month
5.95/Month
4. 1 Voice Customer Authorization (Services provided by ComTech21 DBA Prescient Worldwide) TO: All Local Exchange Companies (LECs), Long Distance Companies (IXCs), Resellers, Rebillers, and Regional Bell Operating Companies (RBOCs). In accordance with this executed agreement, I/We (“Customer”) do hereby authorize 1Voice Worldwide (services provided by ComTech21) to act as our communications agent to place service orders, change network carriers, obtain telephone account information/numbers, PIC codes, and any other customer information needed to assign 1Voice Worldwide (services provided by ComTech21) agency to vendors and authorizing them to implement contracted services for local, data, wireless, IP, interstate, intrastate, intralata and/o international long distance services (“Services”). Customer understands that state to state rates may differ from intrastate rates, intralata toll and international rates. Domestic rates are billed on a six (6) second increments. International rates are billed on a thirty (30) second initial increments and six (6) seconds thereafter. Calls to Mexico are billed in full minute increments. Travel Card services are billed in full minute initial increments and six (6) seconds thereafter. Unlimited long distance and/or free minutes apply to domestic 1+ calls only. Customer’s bill also includes various taxes, monthly fees and surcharges authorized by federal, local and state governments which may exceed $10 per month per line. Service is designed for residential voice usage only. Excessive call volume or excessive or unusual usage may result in additional charges or interruption of Services. Service availability is subject to customer meeting credit criteria. Customer provides authorization to perform credit checks and investigate customer's bank and other credit references, where permitted by law. By executing this Service Agreement Customer agrees to the additional terms and conditions set forth at http://securedcontent.net/1voiceww/screpaccess_terms_and_conditions.html. If you are unable to access this link please contact us at 404921-0388 to request a copy of these additional terms and conditions. I warrant that I have the legal authority to bind the undersigned to this agreement and that I am free of any third-party obligation preventing me from authorizing ComTech21 and/or its authorized agents to act as my agent.
_________ My initial's here confirm that I understand if DSL is currently on my existing line (which is being moved to 1Voice) I will no longer have DSL, and all features not noted on this form will no longer be available unless selected. Authorized Signature____________________________________________________________________ Date_______________ Printed Name____________________________________________________________________________
Rep Name Printed
Rep Signature
Rev 5/18/07
Rep I.D.
1770 Indian Trail Road. Suite 200 Norcross, Georgia 30093
1. Customer Information
First Name
( Name must be as it appears on phone bill)
M.I.
Last Name
Contact Number
(Required)
Billing Telephone Number *(Write "New" if requesting a new number)
Service Address
Social Security Number
(Required)
AZ City
State
Zip
Email Address
2. Billing Information (if different than above) Address_________________________________________City_________________________________State_______ Zip________________ 3. Bundled Local/Long Distance Products Plan Names Zone1 MRC Zone2 MRC Zone3 MRC Carrier Code Local Calling Minutes IntraLata Rate IntraState Rate State-to State Rate Free Long Distance Install Fee (new lines only) Caller ID Name Display Call Waiting w/Caller ID Call Forwarding Three Way Calling
| | | | | | | | | | | | | | |
❏ 31.99/Month ❏ 57.99/Month ❏ 0432 Unlimited 8.7 Cents/Min 8.7 Cents/Min 3.9 Cents/Min 0 65.00 Included Included Included Included ❏ Yes I would like travel cards
Travel Cards
Card#1 PIN: Voice Mail Inside Wire Maintenance Auto Redial Speed Calling 8 Call Screening Auto Call Back (*69) Distinctive Ring 1 Distinctive Ring 2 Non-Listed Number Non Published Number
| | Please note that proper wiring | and phone jacks | are required for | this service. If | Inside wiring is | necessary then | additional | charges will | apply. | FREE SERVICES | | | |
Local 25.99/Month
| | | | | | | | | |
❏ ❏ 2.50/Month ❏ 1.25/Month ❏ 2.50/Month ❏ 2.50/Month ❏ 2.50/Month ❏ 2.50/Month ❏ 1.75/Month ❏ 4.95/Month ❏ 6.95/Month
5.95/Month
| | | | | | | | | | | | | | |
| | | | | | | | | | |
Bundled
❏ 51.99/Month ❏ 77.99/Month ❏ 45.99/Month
0432 Unlimited Unlimited Unlimited Unlimited Unlimited 65.00
| | | |
Included Included Included Included
Quantity: Card#2 PIN:
ADDITIONAL SERVICES | | | | | | | | | |
Card#3 PIN:
| | | | | | | | | |
❏ ❏ 2.50/Month ❏ 1.25/Month ❏ 2.50/Month ❏ 2.50/Month ❏ 2.50/Month ❏ 2.50/Month ❏ 1.75/Month ❏ 4.95/Month ❏
| | | | | | | | | |
6.95/Month
5.95/Month
4. 1 Voice Customer Authorization (Services provided by ComTech21 DBA Prescient Worldwide) TO: All Local Exchange Companies (LECs), Long Distance Companies (IXCs), Resellers, Rebillers, and Regional Bell Operating Companies (RBOCs). In accordance with this executed agreement, I/We (“Customer”) do hereby authorize 1Voice Worldwide (services provided by ComTech21) to act as our communications agent to place service orders, change network carriers, obtain telephone account information/numbers, PIC codes, and any other customer information needed to assign 1Voice Worldwide (services provided by ComTech21) agency to vendors and authorizing them to implement contracted services for local, data, wireless, IP, interstate, intrastate, intralata and/o international long distance services (“Services”). Customer understands that state to state rates may differ from intrastate rates, intralata toll and international rates. Domestic rates are billed on a six (6) second increments. International rates are billed on a thirty (30) second initial increments and six (6) seconds thereafter. Calls to Mexico are billed in full minute increments. Travel Card services are billed in full minute initial increments and six (6) seconds thereafter. Unlimited long distance and/or free minutes apply to domestic 1+ calls only. Customer’s bill also includes various taxes, monthly fees and surcharges authorized by federal, local and state governments which may exceed $10 per month per line. Service is designed for residential voice usage only. Excessive call volume or excessive or unusual usage may result in additional charges or interruption of Services. Service availability is subject to customer meeting credit criteria. Customer provides authorization to perform credit checks and investigate customer's bank and other credit references, where permitted by law. By executing this Service Agreement Customer agrees to the additional terms and conditions set forth at http://securedcontent.net/1voiceww/screpaccess_terms_and_conditions.html. If you are unable to access this link please contact us at 404921-0388 to request a copy of these additional terms and conditions. I warrant that I have the legal authority to bind the undersigned to this agreement and that I am free of any third-party obligation preventing me from authorizing ComTech21 and/or its authorized agents to act as my agent.
_________ My initial's here confirm that I understand if DSL is currently on my existing line (which is being moved to 1Voice) I will no longer have DSL, and all features not noted on this form will no longer be available unless selected. Authorized Signature____________________________________________________________________ Date_______________ Printed Name____________________________________________________________________________
Rep Name Printed
Rep Signature
Rev 5/18/07
Rep I.D.
