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Western Broadband Digital Phone Letter of Authorization

Dear Customer: Thank you for choosing Western Broadband as your Digital Telephone Service provider. By signing this Letter of Authorization. You are indicating your desire to continue to use your existing telephone number with Western Broadband Digital Phone. The service provided by Western Broadband for this number will cover local and long distance calls including intrastate, interstate and international calls. This letter serves as proof that you have explicitly authorized and requested that your service and current telephone number be transferred to Western Broadband. By signing and dating this letter, you provide us with the authorization to initiate the process of transferring your service and telephone number to Western Broadband.

Customer Name: ___________________________________________ Customer Address: __________________________________________ Customer City: ________________; State______; Zip Code_________ Current Service Provider: ____________________________________ Current Telephone Number (_ _ _) - _ _ _ - _ _ _ _ (No cell phones or pagers) PLEASE DO NOT PLACE ANY NEW SERVICE ORDERS WITH YOUR CURRENT SERVICE PROVIDER FOR THE NUMBER(S) NOTED ABOVE, AS THIS WILL CAUSE DELAYS IN TRANSFERING YOUR NUMBER. Please read the following carefully, and sign your name at the bottom of the page: I acknowledge that I have read and understand the terms of this authorization. I am at least (18) years of age, and legally authorized to switch telephone companies for services to the telephone number(s) listed above. I further certify that the information on this Letter of Authorization is correct to the best of my knowledge. I also understand that Western Broadband may have different calling areas, rates and charges than my current telephone company, and that by signing below I indicate that I understand those differences (if any) and am willing to be billed accordingly. Should I wish to later return to my current telephone company, I understand that I may be required to pay a reconnection charge to that company. I understand and acknowledge that, where available, the emergency call service I receive from Western Broadband Digital Phone is subject to certain limitations that did not exist with the emergency services (911 and/or E911) I previously received with my traditional local telephone service. I have read my Subscriber Acknowledgement Agreement and reviewed the Western Broadband website and understand the limitations of emergency services I will be receiving with my new service. By signing below I designate Western Broadband, or its designated agent, to transfer my service from my current provider to Western Broadband. By signing below I also authorize Western Broadband or its designated agent to transfer my current telephone number used to provide service so that Western Broadband may provide its Digital Phone to me. By signing below, I also authorize Western Broadband or its designated agent to obtain billing information, customer service records and other network information required to provide me with Western Broadband Digital Phone.

Signature: _______________________________ Date: ___________________ PLEASE FAX THIS FORM TO (480) 895-3150 Or drop it off at our office Western Broadband 9666 E. Riggs Road, Suite 108 Sun Lakes, AZ 85248 Please be sure to sign and date this form


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