Long Distance Order Form

Complete this form to order WIN long distance telephone service and extra features. Please leave a phone number and best time to call so that we may complete your order. Once you hit submit this order will be emailed to our customer serivce team.

Name:
Address:
City:
State:
Zip Code:
Phone:			Best Time to Call:
Secondary Phone:
email:
I would like to sign up for:
WIN PREMIER		No per month charge 14¢ anytime 6 Second Billing Increments
WIN ONE RATE		$4.95 per month charge 10¢ ALL CALLS ~ ALWAYS 6 Second Billing Increments
WIN Unlimited		Only available with WIN local telephone. Please call for pricing.
800 Number		Get your very own toll-free number
PIC Freeze	900# Block	Toll Block
3rd Party & Collect	3rd Party Only	Collect Only	No Block

Additional Questions/Comments:

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Long Distance Order Form