Required fields are marked with an asterisk (*)

First Name*
Last Name*
Billing Address* (as appears on phone bill)
City*
State*
Zip*
Listed Phone Number* (Area Code first)
TELEPHONE NUMBERS FOR SERVICE (WTNs)
List all telephone, fax and modem numbers including the area code, that you would like to switch at this time.
1. 2.
3. 4.
List any 800 NUMBERS FOR SERVICE that you would like to switch at this time.
1. 2.
3. 4.

The individual authorizes NationsTel to provide long distance service, and to act as agent in all matters related to providing this service.

The individual authorizes any Local Company (LEC) or Long Distance Carrier (LDC) to make pertinent information available to NationsTel and/or its representative. This information will include but will not be limited to main line numbers (BTN) and associated working telephone numbers (WTN).

Any LEC or LDC is authorized to deal directly with NationsTel in providing the above information.
The URL of Radio Station you contacted us through
I verify that I'm over 18 years of age and have the authority to make this request and switch for the previously identified phone number(s).
Type your full name*