Customer Authorization

The undersigned authorizes Trans Texas Technologies Long Distance (3TLD) to provide Long Distance service. (Please check only one plan)

PLAN 1 8¢ per minute - $4.95 Monthly Fee	Check box for travel calling card
PLAN 2 10¢ per minute - $2.95 Monthly Fee
PLAN 3 15¢ per minute – No Monthly Fee

General Terms and Conditions

All Trans Texas Technologies Long Distance (3TLD) charges and other terms and conditions are governed by the applicable Trans Texas Technologies Long Distance (3TLD) tariffs or consumer service agreements and service guides, as applicable, as they may be amended from time to time. Visit www.transtexastechnologies.com to view Trans Texas Technologies Long Distance (3TLD) tariffs or consumer service agreements and service guides. Your telephone company will charge a PIC change fee of $5.00 per jurisdiction/per line for changing your long distance carrier. 3TLD will reimburse you the PIC change fee of $5.00 per jurisdiction/per line on your first billing.

Customer and Billing Information

My signature on this form authorizes Trans Texas Technologies Long Distance (3TLD) to provide long distance service for:

Both Inter/IntraLATA

InterLATA

IntraLATA

*Only one monthly fee will be charged

Customer Signature ______________________________________ Print Name _____________________

Address _______________________________________________________________________________

Billing Address (if different from above) _______________________________________________________

Customer Phone _______________________ Customer Tax ID____________________ Date___________

3TLD Internal Use Only

3TLD Acct # _____________________________ In-Service Date _______________ SO # _____________

3TLD Representative ___________________________________ E-Mail_____________________________

Fax Number _______________________________ Phone Number________________________________

CPNI Information:

Yes, consent given

No, consent denied

Trans Texas Technologies Long Distance (3TLD) Confidential Information.