Long Distance Order Form

Please fill out this form if you would like to sign up for WIN long distance services. Long distance service rates are explained in further detail on the WIN Long Distance page. Be sure to select your desired long distance package and click 'submit'. WIN Long distance services are available nationwide regardless of your local telephone provider. You may also wish to request a PIC Freeze.

Name:
Company Name:			If applying for a business 800 number.
Address:
City::
State:	Choose a State Outside US / Canada Alabama Alaska Alberta American Samoa Arizona Arkansas Armed Forces Americas Armed Forces Europe Armed Forces Pacific British Columbia California Colorado Connecticut Delaware District Of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Northern Mariana Is Northwest Territories Nova Scotia Ohio Oklahoma Ontario Oregon Palau Pennsylvania Prince Edward Island Province du Quebec Puerto Rico Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Yukon Territory
Zip Code::
Phone:
Secondary Phone :
email:
Social Security #:
I would like to sign up for:	WIN PREMIER Long distance	No per month charge 14¢ anytime 6 Second Billing Increments
	WIN ONE RATE Long distance	$4.95 per month charge 10¢ ALL CALLS ~ ALWAYS 6 Second Billing Increments
Additional Questions:
Contact Numbers:			Please leave any numbers where you can be reached to verify any additional information that may be required.

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