Telephone Service Order Step 1 of 4 25% Before we can process your order for LymeFiber telephone service, we need some additional details. Please complete the form below to the best of your ability. A comment box is provided at the end of the form if you have any questions or concerns.WOULD YOU LIKE TO KEEP YOUR CURRENT TELEPHONE NUMBER?* I would like to keep my existing telephone number No, please issue me a new telephone number Please do not cancel service with your current telephone provider. An order to cancel telephone service will result in the loss of your telephone number and LymeFiber will be unable to complete the transfer.YOUR CURRENT TELEPHONE PROVIDER* Consolidated Communications (formerly Fairpoint) Comcast Verizon Wavecomm AT&T TDS For Residential accounts, telephone lines cost $25 per month, plus taxes and fees. For Business accounts, telephone lines cost $35 per month, plus taxes and fees. There is a $30 fee to activate a telephone line. If you received a link to this form in an email from LymeFiber and would not like telephone service, please respond to that email and let us know that you’re not interested. NAME ON ACCOUNT WITH LYMEFIBER* First Last BUSINESS NAME (IF APPLICABLE)BEST CONTACT TELEPHONE NUMBER*EMAIL ADDRESS* Enter Email Confirm Email Most of the communication between LymeFiber and the subscriber will be via email, so please be sure the email address is correct. Please add support@lymefiber.net to your anti-spam whitelist and/or add it to your contacts list to avoid missing communications.LYMEFIBER SERVICE ADDRESS* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code THE LOCATION HAS A SECURITY SYSTEM* Yes No LymeFiber needs this information to determine what equipment we will use during the install. This is only applicable to security systems which use a telephone line to dial out. ELECTRONIC RECORD CONSENT I consent to the use of electronic records By checking the box above, you agree to the use of electronic records to authorize LymeFiber as your agent in the transferal of your telephone number from your current provider. The authorization form is provided on the next page. You understand that you may request a copy of this authorization by contacting LymeFiber at (603)795-0915 or emailing support@lymefiber.net. You understand that you must have a computer or other device capable of accessing the Internet and viewing PDF files and webpages in order to review the electronic record. You understand that you may opt out of the use of electronic records by leaving the box above unchecked, then printing and filling out a paper version of the form and scanning/emailing or mailing it to LymeFiber. Because you did not consent to the use of electronic records, you will need to print, fill, and return the LOA form authorizing LymeFiber to port your telephone number. The LOA will be provided to you after completing this form. Please click the “Previous” button below if you would prefer to complete this form online on the next page. This page is used to authorize LymeFiber’s transferal of your telephone number from your current provider.Your name, billing address, and telephone numbers must match the information on file with your current provider.AUTHORIZED NAME ON ACCOUNT WITH CURRENT TELEPHONE PROVIDER* First Last BILLING ADDRESS ON ACCOUNT WITH CURRENT TELEPHONE PROVIDER* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code NUMBER OF TELEPHONE LINES TRANSFERRING FROM CURRENT PROVIDER*12345678TELEPHONE NUMBER TO TRANSFER FROM CURRENT PROVIDER*FIRST TELEPHONE NUMBER TO TRANSFER FROM CURRENT PROVIDER*SECOND TELEPHONE NUMBER TO TRANSFER FROM CURRENT PROVIDER*THIRD TELEPHONE NUMBER TO TRANSFER FROM CURRENT PROVIDER*FOURTH TELEPHONE NUMBER TO TRANSFER FROM CURRENT PROVIDER*FIFTH TELEPHONE NUMBER TO TRANSFER FROM CURRENT PROVIDER*SIXTH TELEPHONE NUMBER TO TRANSFER FROM CURRENT PROVIDER*SEVENTH TELEPHONE NUMBER TO TRANSFER FROM CURRENT PROVIDER*EIGHTH TELEPHONE NUMBER TO TRANSFER FROM CURRENT PROVIDER*AGREEMENT TO TRANSFER TELEHONE SERVICE* I permit LymeFiber to act as my agent in the transfer of my telephone number You would like your telephone number(s) transferred to LymeFiber. You designate LymeFiber to act on your behalf to facilitate the transfer of your telephone number(s) from your current provider to LymeFiber. You understand that only one telecommunications carrier may operate your telephone number, and completion of this authorization form will result in LymeFiber becoming the sole carrier of your telephone number(s) (documented above) on an agreed date to be scheduled in the future. HOW MANY NEW TELEPHONE LINES DO YOU NEED?*12345678HOW WOULD YOU LIKE YOUR OUTBOUND CALLER ID FORMATTED?*0 of 15 max characters(i.e., How should your name displayed on your friend’s phone when you call?). Please note you are limited to 15 characters, including spaces, and that no special characters are allowed except commas and periods!WOULD YOU LIKE YOUR TELEPHONE NUMBER LISTED IN THE DIRECTORY?* Yes No HOW WOULD YOU LIKE YOUR NAME TO APPEAR IN THE DIRECTORY?*DIGITAL VOICEMAIL SERVICE (optional) Add voicemail service Our optional voicemail service allows you to check messages from any phone or web browser and includes the option to have voice messages forwarded to an email address of your choice. Our voicemail service works when the power, phone service, and/or Internet service is not working at your house. SPECIAL INSTRUCTIONS, COMMENTS, OR QUESTIONSPlease include any special instructions or questions you have for our team.CONTRACT FEES WITH YOUR CURRENT PROVIDER* I Agree I understand that I am responsible for any early contract termination fees levied by my current phone provider (I.e., Fairpoint/Consolidated, Comcast, Exede, Wildblue, WaveComm etc). TERMS AND CONDITIONS* I have read and agree to the terms and conditions set forth in the LymeFiber Subscriber Agreement PLEASE TYPE YOUR NAME*By typing your name you agree that you have answered all of the previous questions to the best of your ability.
