Letter of Agency Service Agreement

Letter of Agency Service Agreement

* designates a required field
This Letter of Agency authorizes Aureon™ Communications, LLC ("Aureon") to act as our communications representative agent.

Please Initial all applicable authorizations. This Letter of Agency rescinds any other Letter of Agency previously entered into by the undersigned.
I authorize Aureon to inquire on our current telecommunication records.*
Initial Only
I authorize Aureon to provide the following services for telephone number(s) listed.*
Initial Only
I authorize Aureon to perform such an investigation as may be necessary to determine the acceptability of this application and to request credit history information from any bank or trade reference in accordance with applicable state and federal rules and regulations*
Initial Only
Current Service Provider*
Windstream Access-Code
Billing Address

(as it appears on your current phone bill)
Name*
Street Address/PO Box*
Ste/Apt
City*
Zip*
Billing Number*
Service Address

(if different than Billing Address)
Company Name
Street Address/PO Box
Ste./Apt#
City
Zip
Directory Listing
Do you want phone number published in phone book?*

UnpublishedPublished
If published, list name(s) here
Telephone Numbers
Telephone Number 1
Telephone Number 2
Telephone Number 3
Telephone Number 4
Telephone Number 5
Telephone Number 6
Telephone Number 7
Telephone Number 8
Telephone Number 9
Telephone Number 10
Telephone Number 11
Telephone Number 12
Fax Numbers
Fax Number 1
Fax Number 2
Fax Number 3
Fax Number 4
Contact Information
Name*
Phone Number*
E-Mail Address*
example@example.com
Free Services

Call WaitingCaller ID
I certify that I have read and understand this Letter of Agency. I certify I am at least 18 years of age, and I am authorized to change telephone companies for services for the telephone numbers listed above. I understand that I am responsible for charges from previous provider. In addition, I understand that I may designate only one carrier for each of these services for the telephone number(s) listed.
Authorized Customer Signature*

Clear
Date*

MonthDayYear
Date
Print Name*
Should be Empty:

Letter of Agency Service Agreement

Billing Address

Service Address

Directory Listing

Telephone Numbers

Fax Numbers

Contact Information