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Location and Billing Information
(Name, address and telephone number MUST be entered exactly as it appears on your local telephone bill)
* Indicates required field
Were you or are you currently a GeoTel Customer?*
Yes No
Email Address*:
First Name*:
Middle Initial
Last Name*:
Date of Birth (mm/dd/yyyy)*: //
Social Security Number:
Street Address*:
Zip Code*:
Daytime Phone Number*: -
Account Information
Main Telephone Number*: -
Local Telephone Company*:
Current Long Distance Company:
Enter up to three telephone numbers you would like to switch over to GeoTel:
I would like to have the following number of Calling cards:
0 (I do not need a calling card)
Customer Approval

(Please read all the following information before submitting form)

By submitting this form, I authorize GeoTel Communication Services, Inc. to act on my behalf to notify my local telephone company that I am choosing Geotel as my primary carrier for residential state-to-state, in-state and international long distance service (and local service where available) for the telephone number(s) and my local phone company may apply a small fee for this change. I am authorized to change the long distance service for the telephone number(s) above. The undersigned has read, understands, and agrees to be bound by the terms and conditions set forth by GeoTel Communication Services, Inc.