Affinity Telecommunications with a Purpose

El Porvenir Service Request Form (Residential)
[To request a Commercial Service form, email or phone 510/595-4626]

Four ways to apply:

By Email: Fill out this form and click the SUBMIT button at the bottom. NOTE: We will either phone you to confirm your application or mail you a form to obtain your signature.
By Mail: Fill out this form including your signature, and send to:
Steve Freedkin, El Porvenir Affinity, 2887 College Ave. #274, Berkeley, CA 94705-2154
By Fax: Fax completed, signed form to: (309) 422-0475
By Phone: Follow the instructions on the main Affinity Long Distance information page for signing up via a toll-free call.

Please print clearly in ink and fill in all information.

CHOOSE YOUR RATE PLAN (select one):

9.9c per minute, all the time, interstate (minimum $3 per month*)
*If usage is below $3 in a month, charge will be $3 for calling time that month.

5.9¢ per minute, all the time, interstate (with $2.95 monthly fee)
Best plan if you call more than 75 minutes per month or make international calls.

For businesses, the rate is 5.9c per minute, all the time, interstate
(Business service request form will be provided.)

(For all plans, in-state, international, AK, HI, VI, and PR calls have different rates; inquire.)


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:


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: ()   -  

      Additional number:     ()   -  

      Additional number:     ()   -  


I would like to order  Calling Card(s).


Your Email: 

Comments or Questions:

By giving my name below, I authorize Affinity Corporation ("Affinity") to act as my agent and to switch my Interstate/InterLATA, Intrastate/IntraLATA (where available) and International long distance service to Affinity. As a result, Affinity will notify my local telephone company of my choice to switch to Affinity long distance service. I understand I may choose one primary carrier for my local long distance (Intrastate/IntraLATA) carrier. My local telephone company may apply a small switch fee, and Affinity will provide a credit certificate to help offset this fee. If I decide in the future to switch to another primary long distance carrier, there could be an additional charge assessed by my local company. I accept responsibility for payment of all charges incurred with the use of Affinity's services and understand this transaction is conditioned upon credit approval. I give permission and authorization to Affinity Corporation to review information reasonably necessary to evaluate credit. I choose Affinity as my carrier for (one or both): Interstate/Intrastate calls (long distance) IntraLATA (toll calls within my local calling area) If you make international calls, you'll want this plan too: Heavily discounted international calling plan ($3 monthly fee)



Type Your Name Here: 

If mailing
or faxing:
Signature_____________________________________________


ORG#981047-888; REP#141-014285




Or, follow instructions below to mail or fax




RETURN THIS FORM TO:         Steve Freedkin
                             El Porvenir Affinity
                             2887 College Ave. #274
                             Berkeley, CA 94705-2154

                             Fax: (309) 422-0475
                             Phone: (510) 595-4626
                             E-Mail:

Note: depending on your browser and printer setup, this form may print out on more than one page. Don't worry, just send in both pages.

Back to the Affinity Info Page | Top of This Page