<< HIT THE 'P' KEY TO PRINT >> BUSINESS SERVICE REQUEST FORM A.F.I. LONG DISTANCE SERVICE - SERVICE REQUEST AGREEMENT NAME> CONTACT> TITLE> STREET ADD> COUNTY> CITY> STATE> ZIP> BILLING ADDRESS, IF DIFERENT FROM ABOVE> CONTACT> PHONE> BUSINESS OR PERSONAL?> BUSINESS BANK> BRANCH> ACCT NO> TRADE REFERENCE1> CONTACT> PHONE> TRADE REFERENCE2> CONTACT> PHONE> PRESENT CARRIER> EST. MONTLY LONG DISTANCE BILL> FED. TAX ID> SERVICE INFORMATION: HOW MANY NUMBERS> LIST BELOW ALL PHONE NUMBERS. IDENTIFY WHICH LINES ARE BILLING TELEPHONE NUMBERS (BTN) NOTE: YOU MAY HAVE MORE THAN ONE BTN. ALSO SPECIFY LINE TYPE PER CODE: F= FAX, M= MODEM, V= VOICE. AREA CODE NUMBER BTN TYPE 1. - AREA CODE NUMBER BTN TYPE 2. - AREA CODE NUMBER BTN TYPE 3. - AREA CODE NUMBER BTN TYPE 4. - AREA CODE NUMBER BTN TYPE 5. - AREA CODE NUMBER BTN TYPE 6. - AREA CODE NUMBER BTN TYPE 7. - AREA CODE NUMBER BTN TYPE 8. - I hereby authorize Affinity Fund, Inc. or their authorized representative to transfer my long distance line carrier. I understand that my local operating company may charge a fee to perform the transfer. I accept responsibility for all changes associated with the above telephone number. _____________________________________________________________________________ AUTHORIZED SIGNATURE TITLE DATE _____________________________________________________________________________ PRINT NAME _____________________________________________________________________________ OFFICE USE ONLY ANI CONSULTANT SIGNATURE CONSULTANT ID CODE: 747-0180 SEND COMPLETED REQUEST FORM TO: OR FAX TO: (408) 423-0131 LIGHTHOUSE PRODUCTIONS P.O. BOX 7885 SANTA CRUZ, CA 95060