Letter of Agency
Name of Authorized Person to Act on Behalf of the Customer/Bunsiness:
Contact Number and email for Authorized Person:
Billing Address if Different than Service Address:
Purpose of this Document:
The Customer's signature on this document authorizes Citizens Telephone Cooperative
- To act as the customers agent in all matters concerning the provisioning of telecommunications services (the "Services") currently received by the Customer
- To disclose, share and/or exchange information pertaining to the Customer
Customer Services Transfer
The Customer appoints Citizens Telephone Cooperative as its agent to attend to all matters, to take such reasonable actions and to execute on the Customers behalf all documentation required to terminate or transfer or assign in favor of Citizens Telephone Cooperative the telecommunications services ("the Services") currently received by the Customer. For greater certainty, and without limitation, Citizens Telephone Cooperative may execute and deliver on behalf of the Customer all letters and agreements of agency and all authorizations and designations of whatever kind required to affect the termination, transfer or assignment of services.
The services provided by Citizens Telephone Cooperative are as follows for:
Service Number to Port:
Porting Number From Service Carrier:
Existing Carrier Account #:
If you are porting multiple phone numbers, upload them here. (CSV file is preferred)
This authorization will remain in effect until further written notice by the customer
Member/Applicant Signature:
Signature verifies all information above is correct