Customer Information

Customer Name________________________________________________________________

Account Name (exactly as it appears on your current toll-free bill)_____________________________________

To insure proper transfer of your existing toll-free number, please attach the front page of the telephone bill from your current toll-free carrier.

Street Address (as it appears on your current phone bill)_____________________________________

City___________________________________   State_____________   Zip Code__________________

*Mailing / Billing Address (if different)________________________________________________

City___________________________________   State_____________   Zip Code__________________


Toll-Free Numbers to be Transferred
I, the undersigned, hereby authorize PowerNet Global Communications to act as my agent for the following toll-free numbers(s):
Toll-Free Number(s) Ring-To Number(s) Current Carrier Switched Dedicated
(____)_____-________ (____)_____-________ ________   ____   ____
(____)_____-________ (____)_____-________ ________   ____   ____
(____)_____-________ (____)_____-________ ________   ____   ____
(____)_____-________ (____)_____-________ ________   ____   ____
Agreement and Waiver
  • The undersigned is not an agent for any third party.
  • The undersigned represents and warrants that they are the exclusive end user/subscriber of the toll-free number(s) listed herein.
  • The undersigned authorizes PNG Telecommunications, Inc. as agent for the appointment of responsible organization for the toll-free number(s) listed herein.

I understand and agree with the above information:

Authorized Customer Signature______________________________________   Date ____/_____/______

Printed Name_______________________________________________________________________

Agent ID: TFBNET| Fax this form to 877-276-4764 for processing