ACN Long Distance

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Residential Long Distance
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CHOOSE ONE 4.9 cents per minute state-to-state $4.99 Monthly fee 24hrs a day - 7 days a week Choice 30 30 state-to-state minutes for $1.99 (6.6 cents per minute) (Additional minutes are 8.9 ¢)	OPTIONAL International Calling Plan Additional $3.00 per month (view rates) HOME TOLL FREE SERVICE 10 cents a minute / No monthly charge
First Name Last Name Address City State Zip Previous address (if at current address for less than 2 years) Address City State Zip Social Security Number OR Date of Birth -- MM/DD/YY Please provide either or both of SSN / Date of Birth to increase the speed at which we can activate your account. Email Address
BILLING INFORMATION (if different from above) First Name Last Name Address City State Zip
I agree to subscribe the following phone numbers to ACN: Main Additional Additional	Yes, I would like calling card(s) with the following name(s): Card #1 Name Card #2 Name Card #3 Name Card #4 Name
Optional: I choose ACN to be my prefered carrier for local toll calls (where available).
CUSTOMER AUTHORIZATION I certify that i am at least 18 years of age. The phone numbers listed on the authorization are listed in my name and or I am authorized to change the long distance service. I understand that my local phone company may charge me a fee to switch long distance carriers, and that I may designante only one primary interexchange carrier for any one telephone number for local toll calls (where applicable). I further understand that to have ACN local toll service, I must also subscribe to ACN service for state-to-state, in-state and international calling as well. Selection of ACN will apply to the telephone number(s) listed on this form. ACN may use any information obtained through this service application or from any credit reporting agencies.
ACN Communication Services, Inc. ACN World Headquarters, P.O. Box 9000, Farmington Hills, MI 48333-9000