9449 State Highway 197
LETTER OF AGENCY
To Whom It May Concern:
_____________________________________________(Known as “the User”) appoints Country Cablevision, Inc. (Known as “The Service Provider”) and its affiliates as an agent for the purpose of ordering, changing and/or maintaining communication services including but not limited to local, long distance and private line services. The Service provider is also authorized to obtain billing information, customer service records (CSRs), directory listing information, audit information and all customer proprietary network information related to the User. This authorization will remain in effect until rescinded in writing by the User.
LSP Name (Local Service Provider):__________________________________________
BAN (Billing Account Number):_____________________________________________
Phone Numbers to be Ported:_______________________________________________