By filling out this form I request to take responsibility for the accounts noted below and in consideration agree(s) to pay the ongoing monthly service charges and any other applicable charges, including but not limited to: current and/or unbilled phone, long distance, TV, internet, pay-per-view, directory listings, yellow page ads, digital advertising, etc., current and/or outstanding/past due balances associated with the account(s) as of the transfer date. (Long distance charges may take several months to appear on the statement.) I understand any current commitments for the service will need to be fulfilled to avoid any early termination fees if services are disconnected. I certify that the information I have entered is true and correct to the best of my knowledge. I authorize Arvig to check my credit to verify information as stated on this application.