EmailMe Form - NVC Authorization Form

Name *

First Last

Email *

Daytime Phone Number

### - ### - ####

Address

Street Address

City

Zip Code

*

I authorize NVC to request & receive data & billing information & to act as my representative for telecommunications. NVC is authorized to notify our local & long distance telephone companies of my telecommunications choices for the above location.

I authorize NVC to switch my outbound service to NVC and to freeze my local and PIC choices with NVC until further written notice from me.

I authorize NVC to obtain a credit report on myself through the credit reporting agency of its' choice.

Electronic Signature Agreement.

By selecting the "I Accept" button, you are signing your agreement with NVC electronically. You agree your electronic signature is the legal equivalent of your
manual signature. By selecting "I Accept" you consent to be legally bound by NVC's terms and conditions.

Name *

First Last

*

I Accept