Long Distance PIC Change Authorization Form

Type of Service

Residential

Business


*Indicates required fields
First Name*
Last Name*
Company
Street*
City* State*
 Zip*
Current Phone Number*
 E-mail Address*
Effective Date:
Additional Numbers on this Account:
Travel Cards:   # Requested
Your Preferred 4 Digit PIN Current Rate: $0.219

Questions or Comments
I Authorize a PIC Freeze (Ensures that your long distance carrier is never
changed without your permission)
*I authorize BEVCOMM to change my long distance to PIC 7123 BEVCOMM / PNG.
BEVCOMM will be changing both inter and intra lata carrier
Name*
Date*

YOUR IP ADDRESS: 38.103.63.16