Authorization to Change Telecommunications Services

Choice Computing Services

Choice Computing Services

Choice Computing Services

Choice Computing Services

Choice Computing Services

Choice Computing Services

Choice Computing Services

Choice Computing Services

Choice Computing Services

Your Name

Your Spouse's Name

Phone # 1

Phone # 2

Street Address

Daytime Contact #

Address Line 2

City

State

ZIPCode

Social Security Number (nnn-nn-nnnn)

Your EMAIL Address

Date of Birth (mm-dd-yyyy)

Current Telephone Provider

Select the Package you prefer:

First Name

Last Name

Phone Listing Preference

Call Blocking Options

Call Blocking Options

Some restrictions and other terms and conditions may apply.  Contact Cavalier or an Authorized Agent for details.  5-cent long distance rate valid for calls originating in the 48 contiguous U.S. states.  Pricing may not reflect current promotional pricing.  Detailed pricing information will be available when you place your order.  DSL service is a best effort service and Cavalier Telephone cannot guarantee the availability of DSL service until your order is completed.  DSL service is not available in all areas or on all telephone lines and is subject to circuit availability.  Actual speeds may vary.  DSL service requires a modem from Cavalier Telephone - shipping is $9.95.  Service activation subject to credit check and approval.  Offer subject to change without notice.  An installation charge may apply for new loops.

Copyright 2004-2005 by Choice Computing Services All Rights Reserved

Disclaimer:  All information submitted to Choice Computing Services through this form is private and confidential, and will be used only for the purpose of qualifying individuals for Telecommunications Services from Cavalier Telephone and its agents.  No data obtained from this form will be sold or shared with any other party.

Each package from Cavalier Telephone includes these FREE Features ...

- Voice Mail - Caller ID - 3-Way Calling - Call-Waiting or        Talking Call Waiting - Unlimited *69 - Remote Call  Forwarding - Speed Dialing - Anonymous Call Rejection - Call-Forwarding - Repeat Dialing *66 - 900 Toll Block - Call Block

Choice Computing Services is an affiliate of Cavalier Telephone