I hereby request and authorize Nortex Communications to freeze the Preferred Carrier on my account on each of the following services. I understand that the purpose of the freeze is to prevent a change in my local toll and/or long distance provider. I also understand that I will not be able to change my carrier selections unless I lift the freeze. Furthermore, I understand there is no charge to initiate and terminate this service, and that there can be a charge to change carriers.

Physical Address

Primary Numbers to be protected by PIC Freeze:

By electronically signing below, I am authorizing Nortex to place a PIC freeze on my account(s). Nortex will not change my long distance carrier providing service without my direct authorization. This means that before I or anyone else changes your specified carrier, one of the following must occur: I authorize Nortex in writing to lift the freeze for the particular service. I orally request Nortex to lift the freeze from the telephone line for which the change is to be made. This telephone call may be on a three-way conference call with the carrier to which you are changing the service and a representative of Nortex. We will ask for identifying information during this call. These actions are required by the FCC in addition to the FCC’s verification procedures for changing a preferred carrier. In some circumstances, a long distance carrier may change your preferred carrier to or from another long distance company which resells the services of that carrier. Nortex has no way of preventing these changes under the current FCC rules. There is no charge for establishing a Preferred Carrier Freeze or for lifting the freeze. The charge for changing carriers for any service is $5.00 per LATA. I consent to the use of electronic records for the purposes as listed in this form. Your Nortex order will be processed within 3-5 business days.

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