Low Rates by DC Network

Signing Up For
Program I

To sign up, please complete the form below and click submit.
All information is required as applicable.

1) Name as it appears on your Local Telephone bill:

2) Does your Local Telephone Company list you as a business or a residential account?

3) Name of your Local Telephone Company:

4) Your company name (if applicable):

5) Contact person for this account (if different than #1):

6) Email address for the contact person:

7) Social Security # or Federal I.D. #:

8) Main number to be switched:

9) Which Rate Program do you want for in-state long distance calling?

10) What is your fax number (if applicable)?

PLEASE ANSWER 11 - 14 IN RELATION TO YOUR MAIN TELEPHONE LINE:

11) Street address (no P.O. Boxes):

12) City:

13) State:

14) Zip Code:

15) Billing Address (if different than above):

16) List the numbers to be switched (put an "M" next to main numbers):

17) Do you want to order a Calling Card for when you are away from home or office?

18) If you answered "Yes" in #16, how many cards do you want to order?

19) If you answered "Yes" in #16, please enter the name(s) as you want to have it printed on your calling card:

20) If you answered "Yes" in #16, what monthly limit do you want to place on your Calling Card?

21) Approximately how much are you spending per month in long distance
calling?

22) Did someone refer you to us? If so, what is the person's name (he or she will receive a FREE 30-minute prepaid phone card)?

Comments:

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