Residential Long Distance
Order Form

Y O U R    I N F O R M A T I O N

NOTE: anything with an (*) is required information

(*)Name:
Company Name:
(*)Street Address:
Business
Home
(*)City, State, Zip:
Cell Phone:
Include area code
Work Phone:
Include area code
Home Phone:
Include area code
Fax:
Include area code
(*)Email:
(*)Date of Birth:


T E L E P H O N E    N U M B E R S    T O    B E    S W I T C H E D

Just fill in your phone numbers (with area code) that you wish to switch to our
Residential 3.9¢ a minute Long Distance Service. Each line will cost $1.95 per month.
For more than 10 phone numbers, please add the additional numbers
to Your Comments at the bottom of the page.

#1 (CLEAR #1) #6 (CLEAR #6)
#2 (CLEAR #2) #7 (CLEAR #7)
#3 (CLEAR #3) #8 (CLEAR #8)
#4 (CLEAR #4) #9 (CLEAR #9)
#5 (CLEAR #5) #10 (CLEAR #10)



C O N T A C T     M E

Please Contact Me about my Order Confirmation at:

     Home Phone      Work Phone 

Best time to call:

 

 

If you ever need personal assistance, you can call
us Monday thru Friday 8am to 6pm or Saturdays
from 10am to 4pm and talk to one of our
Customer Service representatives.

 

F I N A L     A P P R O V A L

YES! - - - I want to switch to the Residential 3.9¢/min. Long Distance Service!

Letter of Agency: Upon Signature of this Agreement, Customer elects San Diego Wireless Communications, Inc. (SDW) as its primary long distance provider and as its agent in all matters relating to long distance services and Authorizes SDW to notify Customer’s local telephone company of this change. Customer understands that they will still be able to place long distance calls with any other carrier, but can have only one primary long distance carrier per phone number. Customer agrees to pay all charges by the due date specified on the bill. Additionally, Customer authorizes SDW to perform the necessary credit investigation to establish this account. Customer acknowledges they have read and agree to abide by SDW’s Terms and Agreement, incorporated herein by reference.

 


Y O U R     C O M M E N T S