UniDial Agreement For New Service

Yes! I want to save money on my long distance calls.

Please switch my long distance carrier to UniDial Communications.

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Name (exactly as it appears on your local telephone bill) Account Number (Internal Use Only)

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Address (No P.O. Box) City State Zip

(____)__________________(___)_______________________(____)________________(____)_________________

Billing Phone Number(as it appears on your phone bill) Additional Phone Number(s)

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Local Telephone Company Previous Long Distance Company

Special Instructions: o Check to exclude Intralata

Please Add 800/877/888 Number to Account Yes / No Ring to Number (_____) ______________________

Please Add Calling Card Yes / No Social Security No._____________________________________

( For Security Purposes Only)

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Name to Appear on Calling Card

Please check if appropriate: o I hereby authorize UniDial to act on my behalf with the Local Exchange Carrier if

applicable to release any & all Pic Freezes associated with my account. Some Local Exchange Carriers

may require additional customer verification.

1 Plus SW Rate Plan*: Interstate__________/ .089 Intrastate _____/______ Intralata _____/____Intl.____/____

Plan/ Rate Plan/ Rate Plan/ Rate Plan/ Rate

*Certain rate plans may be subject to monthly recurring charges.

THE UNDERSIGNED HEREBY AGREES TO THE TERMS AND CONDITIONS OF THIS AGREEMENT FOR NEW SERVICE. I ACKNOWLEDGE THAT THIS AGREEMENT FOR NEW SERVICE IS SUBJECT TO APPROVAL BY UNIDIAL COMMUNICATIONS, INC. (“UNIDIAL”). I HEREBY AUTHORIZE UNIDIAL TO VERIFY ALL LISTED INFORMATION FOR CREDIT PURPOSES.

I HEREBY APPOINT UNIDIAL AS MY PRIMARY LONG DISTANCE CARRIER FOR EQUAL ACCESS SERVICE INCLUDING INTERSTATE, INTRASTATE, INTRALATA AND INTERNATIONAL SERVICE UNLESS I HAVE INDICATED OTHERWISE IN THE SPECIAL INSTRUCTIONS SECTION ON THIS AGREEMENT FOR NEW SERVICE. I APPOINT UNIDIAL TO ACT AS MY AGENT IN ORDER TO EFFECTUATE THE CHANGE(S) AND AUTHORIZE IT TO HANDLE ON MY BEHALF ALL ARRANGEMENTS, INCLUDING ORDERING, CHANGING AND/OR MAINTAINING MY SERVICE. I UNDERSTAND THAT MY LOCAL TELEPHONE COMPANY MAY ASSESS ME A CHARGE FOR ANY CHANGE IN SERVICE. I UNDERSTAND THAT ONLY ONE LONG DISTANCE CARRIER MY BE DESIGNATED AS MY PRIMARY INTERSTATE CARRIER FOR ANY ONE TELEPHONE NUMBER BUT THAT I MAY HAVE THE ABILITY (DEPENDING ON MY LOCATION) TO SELECT SEPARATE LONG DISTANCE CARRIERS FOR OTHER TYPES OF SERVICE. I REPRESENT THAT I AM THE SUBSCRIBER FOR THE TELEPHONE (S) LISTED HEREIN AND/OR HAVE THE AUTHORITY TO CHANGE LONG DISTANCE CARRIERS. THIS AGREEMENT AND THE SERVICES PROVIDED HEREUNDER ARE SUBJECT TO UNIDIAL’S TARIFFS IN EFFECT FROM TIME TO TIME. SOME RESTRICTIONS MAY APPLY.

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AUTHORIZED SIGNATURE PRINT NAME DATE