YOU CAN PRINT THIS PAGE AND FAX BACK TO US (Fax: 213 - 239 - 0920)
INTERNAL USE ONLY -- AGENT ID: _______1141_________________
SERVICE AGREEMENT FOR 8xx
Toll-Free Number Current RESPORG Current RESPORG ID Ring-to Number
Area of Service
______________ _______________ _________________ _____________
48 States
______________ _______________ _________________ _____________
48 States
______________ _______________ _________________ _____________
48 States
______________ _______________ _________________ _____________
48 States
Customer Name: ______________________________________________
Initial One of the Following:
___X____ The undersigned is not an agent for any third party. The undersigned represents and warrants that it is the exclusive end user subscriber if the toll-free (8xx) number(s) listed herein and agrees to indemnify, defend and hold Total Call International harmless from liability and expenses for any breach of that representation and warranty.
_______ The undersigned is acting as an expressed authorized agent on behalf of a third party who controls the toll-free (8xx) number(s) listed above. Please list the third party for which you are acting on behalf of: ______________________.
(Proof of Letter of Agency for telecommunications, including but not limited to RESPORG, is required.)
By signing this form, the undersigned also acknowledges that if this is a new toll-free (8xx) number, this toll-free (8xx) number will not be assigned to undersigned until the toll-free (8xx) number is actually ringing to the ring-to number listed above. The undersigned further represents, warrants and agrees to indemnify, defend and hold Total Call International harmless from any damages that may arise from this new toll-free (8xx) number not being available to the undersigned.
UNDERSTOOD and AGREED
______________________________________________________________ ________________________________
Signature (Required) Date