Customer Physical  Location
First Name:
Last Name:
Zip Code:
Contact Phone Number
Social Security Number
Date of Birth MM-DD-YY 
Uncheck if Billing Adress is diferent form the Phisical Address.
Enter Your Billing Address
Zip Code
Payment type
Credit CardACH Billing
Credit Card
Credit Card Type

Credit Card Number:

Issuer Bank:

Name on Credit Card:

Driver License ID or passport number:

Expiration Date:
3-Digit Security Code:

Credit Card Street:

Credit Card Zip:

Your IP:
Credit Authorization:Customer Authorize N.E.T. to verify credit and banking references and to exchange and/or report on Customer's credit history with N.E.T.
Local exchange company may charge a fee to change the customer's local toll or long distance carrier
Customer designates NET to act as the customer's agent for the preferred carrier change
The customer understands that only one telecommunications carrier may be designated as the customer's interLATA preferred carrier; and that only one telecommunications carrier may be designate as the customer's local exchange provider, for any one telephone number, One telecommunications carrier may be designated as the interstate preferred carrier, one carrier may be designated as the interLATA preferred carrier and one carrier may be designated as the local exchange provider, for any one telephone number.
Current Carrier
Name of the Long Distance Carrier:
Name of the Local Carrier:
Estimated Monthly Long Distance Usage$
Subscribed Lines (Outbound)
1. Line Type: Residential  CellBusiness
2. Line Type: Residential  CellBusiness
Additional Information
Agency and Authorization
IntraLATA Service

I understand I will presubscribed to N.E.T. for any toll calls made within my Local Access Transport Area (IntraLATA) calls, effective when my jurisdiction has approved IntraLATA competition or as soon as practical if currently available. I understand my local telephone company may  assess a service change for each line.
Our Customer service will contact you in 24 hours in order to complete TPV.

I Accept

Letter of Authorization (LOA)Customer Agrees that N.E.T.,Inc. be named as the long distance carrier for the customer named above N.E.T.,Inc. is hereby authorized to coordinate this agreement by making all the necessary arrangements with this customer's local telephone company. In consideration for the services to be provided pursuant to this agreement and other value consideration, the individual signing below hereby personally guarantees all financial obligations of the customer for the WTN's on this service agreement 

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