Country Cablevision
9449 State Highway 197
Burnsville
(828) 682-4074
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effect until rescinded in writing by the User.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:_______________________________________________
_______________________________________________
911 Address:___________________________________________________________
___________________________________________________________
___________________________________________________________
Name:___________________________________________________
Title:____________________________________________________
Company:_______________________________________________
Signature:________________________________________________
Date:__________________________