Toll-Free Number Transfer Request

Toll-Free Number Transfer Request
The undersigned Toll Free number holder does hereby appoint cTel L.L.C. as the Responsible Organization for toll free numbers.
Today's Date*

MonthDayYear
Date

Toll Free Numbers*

	Toll Free	Point To
1
2
3
4
5
6
7
8
9
10

Contact Name*

First NameLast Name
Acct Number*
Acct Pin
Contact Title
Authorized Customer Tel #*
Authorized Customer Fax #
Email*
example@example.com
Current Phone Carrier*
Company Name*
Company Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
New RespOrg Contact: EASTERN REP
New RespOrg Telephone #: (541) 593-2900
New RespOrg Fax #: (541) 593-2090
By selecting the "Submit" button, you are signing this Request electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Request. By selecting "Submit" you consent to be legally bound by this Request's terms and conditions. You further agree that your use of a key pad, mouse or other device to select an item, button, icon or similar act/action, or to otherwise provide cTel, or in accessing or making any transaction regarding any agreement, acknowledgement, consent terms, disclosures or conditions constitutes your signature (hereafter referred to as "E-Signature"), acceptance and agreement as if actually signed by you in writing. You also agree that no certification authority or other third party verification is necessary to validate your E-Signature and that the lack of such certification or third party verification will not in any way affect the enforceability of your E-Signature or any resulting contract between you and cTel. You also represent that you are authorized to submit this Request for all persons who own or are authorized to access any of your accounts and that such persons will be bound by the terms of this Request.
Authorized Customer Signature*

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Date

MonthDayYear
Date
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