| First Name: |
|
| Last Name: |
|
| Middle Initial: |
|
| Birthdate: |
|
| SSN: |
|
|
|
|
Service Address |
| Address: |
|
| Apt: |
|
| City: |
|
| State: |
|
| Zip Code: |
|
|
|
|
Service Details |
| |
New Telephone Service |
| |
Transfer Existing Service |
| Current Phone Number: |
|
| Current Provider: |
|
|
|
|
Choose Your Calling Plan |
| |
C2 Bundle High Speed Internet with Unlimited Basic (Local) and Long Distance Calling $50 |
| |
Unlimited Long Distance Calling $34.95 |
| |
Unlimited Long Distance with 56K Dial Up $44.95 |
| |
Basic (Local) Calling $24.95 |
| |
Basic (Local) Calling with 56k Dial Up $34.95 |
| |
Stand Alone High Speed Internet $39.95 |
|
|
|
Directory Listing |
| |
Fully Published (FREE) |
| |
Non-Listed in 411 not in phone book $1.71 (VA) Per Month $3.95 (DC,DE,MD.NJ,PA,NY) Per Month $5.95 (MI,GA) Per Month $4.40 (OH) Per Month |
Directory Name: (This is the name that will appear in the Caller ID) |
|
|
|
|
Contact Information |
| Daytime Phone: |
|
| Evening Phone: |
|
| Cellular Phone: |
|
| Email Address: |
|
| Comments: |
|
| |
Permission To set up your account, Cavalier Telephone will need to access your telephone records. Your consent will remain in effect until your order is completed, unless you contact Cavalier Customer Care. Cavalier Telephone is required by law to keep this information confidential to protect your privacy and your current services will not be affected. "I name Cavalier Telephone to act as my authorized agent in a change of preferred carrier for telecommunications services to be provided, including local and long distance telephone service. I understand that i am choosing Cavalier Telephone for local telephone service, IntraLATA (In State) toll calls and for interexchange (long distance) services. I understand that I may be subject to a credit check and my service activation is dependent upon my credit standing." Check Box |
|
Terms of Authorization You must read the terms of authorization before continuing. Together with this page that document will authorize Cavalier Telephone to become my preferred telecommunications provider for the services you have chosen. |
|
Order Information Installation charge may apply to existing telephone numbers transferred to Cavalier Telephone based on credit risk. Installation charge will apply to all customers ordering new phone numbers. By submitting this order form, I give Cavalier Telephone permission to check my credit. Installation is $35.95 or waived on the first months bill upon credit approval. Contact Cavalier Telephone or an Authorized Agent for more details. Pricing information is based upon the state or area code and telephone number you provide. Long distance rate valid for calls terminating in the 48 contiguous U.S. states. DSL service is a best effort service and Cavalier Telephone cannot guarantee the availability of DSL service until your order is completed. DSL service is not available in all areas or on all telephone lines and is subject to circuit availability. DSL service requires modem from Cavalier Telephone. The DSL modem is free with online sign up (delivery charge of $9.95 applies). Service activation subject to credit check and approval. Offer subject to change without notice. Some restrictions and other terms and conditions may apply. |
| Authorization: |
|
| |