Change Your Phone Provider

By completing this form and providing my birthdate, I am authorizing TDS Metrocom, LLC ("TDS") to become my new telephone service provider, in place of my current provider(s), for the provision of my local, state-to-state long-distance service, local toll service, and/or international long-distance service as indicated above. I authorize TDS to act as my agent to make this change. I understand that when changing providers, I may be required to pay a one-time charge per line per provider to complete the change or changes. If I later wish to return to my current carrier(s), I may be required to pay a reconnection charge to that company or companies. I understand that I may contact TDS to find out whether a one-time charge to switch providers is applicable. I also understand that TDS may have different calling areas, rates, and charges than my current provider(s) and, that by signing below, I indicate that I understand those differences (if any) and I am willing to be billed accordingly. I certify that I am at least eighteen (18) years of age and that I am authorized to change telephone companies for services to the telephone numbers listed above. I further certify that I am responsible for all valid TDS charges for calling plans and usage. I understand that for each telephone number I may select only one carrier for local service calls, one for interLATA (out-of-state long distance) calls, one for intraLATA (in-state long distance) calls, and, in areas where technically feasible, one carrier for international calls.