Please read our Terms Of Service for Digital Phone Service before submitting. Customer Information Your name should appear EXACTLY as it does on your local phone bill First Name Last Name Service AddressPrimary address where the telephone service will be located. No PO Boxes Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code Business Information Required only if phone service is in your company’s name Business Billing AddressIf different from service address, print EXACTLY as it does on current phone bill Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code List below all Telephone Number(s) for which you authorize change from your current phone service provider to ITU, Inc. d/b/a Independence Telecommunications Utility (“Indytel”). Please note that Local, In-state Toll and /or Long Distance service for the number(s) listed below will be charged to Indytel and that any services associated with this number(s), such as Centrex or DSL will be lost if you port this number(s). Current Service Provider and Account Number Telephone Number(s) List all numbers to be ported. Add each phone number on a new line. Billing Telephone Number (“BTN”) This MUST be provided if number(s) to be ported is a Business Account. Check this box if you have additional numbers on your Business Account that you do NOT want ported. Do Not Port If the number(s) to be ported is a mobile number, please provide the following information Place each number and account number on a new line. VERIFICATION – PLEASE READ BEFORE AGREEING BELOW* By agreeing below, I verify that I am, or represent (for a business), the above-named local service customer, authorized to change the primary carrier(s) for the telephone number(s) listed, and am at least 18 years of age. The name and address I have provided is the name and address on record with my local telephone company for each telephone number listed. I warrant that the address that I have provided above is the address where I will be using this service. I authorize and designate Indytel as my agent and notify my current carrier(s) to change my preferred carrier(s) for the listed number(s) and service(s), to obtain any information Indytel deems necessary to make the carrier change(s), including, for example, an inventory of telephone lines billed to the telephone number(s), carrier or customer identifying information, billing addresses, and my credit history. I further understand that after this process is completed Indytel will become my Local, In-State Toll and Long Distance provider, as indicated above. I understand that I am authorizing change(s) of my primary carriers for these Service(s), and that I may select only one primary carrier per service, per number. I understand that my local telephone company may bill me a one-time charge for requested service change(s) for each telephone number. Agree Leave this field blank
