Acceris Long Distance Plan

Long Distance, International Long Distance

Middle East Plan

LOCATION & BILLING INFORMATION:
(Name, address and telephone number MUST be entered exactly as it appears on yout local telephone bill)


*First Name: ()**

*Last Name: ()**

*Email Address: ()**

*Street Address: ()**

City:

State:

Zip Code:

Daytime Phone Number:	- -

Home Phone Number:	- -

Local Phone Company:

Current Long Distance:

LONG DISTANCE:
Enter up to three telephone numbers other than the home phone number (such as fax, modem lines or additional voice lines, but no cell phones or pagers) you would like to switch over to Primus:


Additional Phone Number1:	- -

Additional Phone Number2:	- -

Additional Phone Number3:	- -

CUSTOMER APPROVAL
Please read all the following information before submitting form.


Enter Today's Date:	MM/DD/YYYY

Date of Birth:	MM/DD/YYYY

By clicking the "submit" button below, I submit this order designating Acceris to act as my agent for purposes of switch my long distance service and/or local toll service to Acceris. I consent to the use of this electronic letter of authorization to record my desire to switch. I acknowledge that I have the necessary software and hardware to submit this form electronically to Primus, and I understand that I may withdraw my consent to use electronic records at any time by contacting Acceris.  By submitting this order, I authorize Acceris to notify my local telephone company of my decision to switch to Acceris as my primary long distance company and/or my carrier for local toll calls. I understand that I may designate only one preferred carrier for each type of long distance service for any telephone number. By submitting this order, I confirm that I am at least 18 years of age and that I am authorized to change telecommunications services for the phone number(s) to be changed. I agree to take the affirmative steps needed to make these switches. I understand that my local telephone company may charge me a fee to switch my services to Acceris, and that I may consult a representative of Acceris about whether a fee applies to my switch. By clicking the "submit" button I certify that I have read and agree to this letter of authorization.

Yes, please switch me to Acceris long distance service.

For questions about our service plans please see our faq's section... Start Here