Best for most people who call less than 50 minutes per month:
      9.9¢ per minute, all the time, interstate (48 contiguous states)
      (Minimum charge for calling time is $3 per month) PLAN 6103

Best if you call more than 50 minutes a month:
      3.9¢ per minute, all the time, interstate (48 contiguous states), plus $2.95 monthly fee
     PLAN 6139

For businesses, the rate is 3.9¢ per minute, all the time, interstate, with
      different rates for in-state and international calls, a 2-year contract, and a $15 monthly
      minimum. Lower rates available for larger customers. Full information will be provided.
 
      (For all plans, calls to same-state, international, AK, HI, VI, and PR numbers have different rates.)

Your Email:


Customer Name (EXACTLY as it appears on current phone billing):



For security purposes, please provide mother's maiden name OR Social Security:

Mother's Maiden Name:  -OR- Social Security No.:  -  - 

Street (P.O. Box not allowed here):



City:     State:     ZIP:  - 

County: 

Billing Address (if different from Street Address; P.O. box okay here):


City:     State:     ZIP:  - 

SERVICE INFORMATION
--> Enter your telephone number, including area code.  The top number should
    be your billing (main) number. If mailing or faxing this form, list additional
    numbers on separate sheet.

      Billing (main) number: ()   -  
--SELECT TYPE OF LINE--
Voice
Modem
Fax
Cellular Phone


      Additional number:     ()   -  
--SELECT TYPE OF LINE--
Voice
Modem
Fax
Cellular Phone


      Additional number:     ()   -  
--SELECT TYPE OF LINE--
Voice
Modem
Fax
Cellular Phone



I would like to order  Calling Card(s)   <-- No charge to receive cards.


Comments or Questions: 

My signature below authorizes CA Affinity to act as our agent in all matters relating to my long distance service/toll free service for the telephone number(s) listed on this form -- in particular, but not limited to, to select and change PIC choice of the transport carrier, and the rates and billing method, and to obtain information relating to my account from my local phone company. I understand this authorization will remain in effect until withdrawn by written notice. I hereby consent to CA Affinity's use of a business/non-business consumer credit report on the undersigned in order to further evaluate the credit worthiness of the undersigned in connection with the extension of credit by this application. I understand: (i) I may only subscribe to one carrier for my InterLATA service. (ii) I may only subscribe to one carrier for my IntraLATA service, and it may be the same or a different carrier than that chosen for my InterLATA provider. (iii) I authorize CA Affinity to call my local phone company and change the current PIC choice. (iv) CA Affinity or the actual underlying carrier's name may appear on my local telephone company. (v) There may be a charge from the local phone company for subscribing my long distance service to transport carrier. (vi) There may be a charge from my local telephone company should I decide or my agent decides to change the long distance transport after my service begins. If this application is accepted and credit is thereby extended, we agree to pay by the stated due date all charges incurred and billed to me for long distance, toll free, calling card usage and any other services contracted for herein or that may be contracted for. (vii) I will be liable for all collection fees with a $20 charge added for NSF checks. Past due balances are subject to a 1.5% per month finance charge. I understand that rates and fees are subject to change and, if I don't pay my bill promptly, that my local telephone carrier may bill me for services and past due balances may be reported to credit bureaus. All parties agree that facsimile signatures are binding.

I choose C.A. Affinity as my carrier for (one or both):

        Interstate/Intrastate calls (long distance)

        IntraLATA (local toll calls)

Type Your Name Here: 


Signature________________________________________________________________________________


ORG#: See top of form -- REP#141-014285


 
You will be mailed a copy of the form for your written signature
Or, follow instructions below to mail or fax




Time saving tip:                           Steve Freedkin
Cut out the address on the right           C.A. Affinity Telecommunications
and stick it on the envelope               5111 Telegraph Ave. #274
you'll use to send in the form.            Oakland, CA 94609-1925

                                           Email: