(Failure to complete ALL sections completely could delay the processing of your order)

*  Required

Account Information

*Account Number or Phone Number:
*Daytime Contact Phone Number:
Email Address:   

Carrier Change Fees:

One-time fee per carrier change as indicated below.  There are no additional service order charges or monthly fees.
Interlata-Carrier - 1st change after initial installation - Free
All other changes - $5.50 one-time charge
Intralata-Carrier - $5.00 for changing anytime
Combo Pic Discount - $7.75
Restricted Pick* - No Charge

Long Distance Carrier Selections:

If you have already signed up for Restricted Pick for Long Distance Carrier and have previously entered a password question and answer into our system, then please enter your password and question below.  Otherwise, a representative from our office will contact you to confirm your request to change your long distance carrier.

Choose Question:
Your Answer to this Question:

Please indicate your preferred long distance carrier.  A carrier MUST be selected for each type of Lata.  For a detailed explanation of InterLata and IntraLata, please check the white page information section in the front of your local phone book or Click Here:  InterLata and IntraLata Info

*  InterLata Carrier:  
*  IntraLata Carrier:  

Add Restricted PIC for Long Distance Carrier (RPIC):

A free option that prevents your long distance carrier choice from being changed unless you either call the business office and request a change, or fill out the on-line form providing the correct password for this action.

*  Do you want to add RPIC?    Yes:     No: 

If Yes, Please Enter a password based on one of the following questions:

Choose Question:
Your Answer to this Question: