Long Distance Service Form

By electronically signing below, I am authorizing Nortex to become my new residential provider of long-distance service and/or local toll service (if available and selected by me). I authorize Nortex to act as my agent to make this change happen, and direct my local company to work with Nortex to affect the change. I understand I may consult with my current carrier as to whether a fee will apply to change to my preferred carrier. If I later wish to return to my current telephone company, I may be required to pay a reconnection charge to that company. I also understand that Nortex may have different calling areas, rates and charges than my current provider, and that by signing below I indicate that I understand those differences (if any) and am willing to be billed accordingly. I authorize Nortex to provide long-distance and/or local toll service to my telephone numbers listed above and no others. I certify that I have read and understand this Letter of Agency. I further certify that I am at least eighteen years of age, and that I am authorized to change telephone companies for services to the telephone numbers listed above. I understand that I may select only one interLATA (long-distance) carrier and only one intraLATA (local toll) carrier for each telephone number. I am responsible for all valid Nortex charges for all usage. Existing Nortex customers will assume responsibility for any domestic or international rate changes that occur through submission of this order. I understand that this application is subject to credit review. I consent to the use of electronic records for the purposes as listed in this letter of agency. Your Nortex order will be processed within 3-5 business days. After this time period, should you choose to return to your previous carrier or another carrier, please contact Nortex. You may call us 940-759-2251 to confirm that your long distance and/or your local toll service has been switched to Nortex as requested. If would like to switch to Nortex Long Distance but do not want to fill out this form, please contact us 940-759-2251. Businesses interested in Nortex Long Distance need to call us at 940-759-2251.