PowerNetGlobal Communications Responsible Organization Change Authorization

Please Print, Complete and Fax to: 1-888-715-3534 for processing
Thank you for choosing PowerNet Global Communications for your toll-free service. This form is used for the transfer of existing toll-free numbers to PowerNet Global, and must be accompanied by a completed Business or Residential Service Application, unless you already have an active account with PowerNet Global.

Customer Information

Customer Name______________________________________________________________ PNG Account Number : MER____________________
(from web page after you've completed Sign up)
Account Name (exactly as it appears on your current toll-free bill)_____________________________________

To insure proper transfer of your existing toll-free number, please attach the front page of the telephone bill from your current toll-free carrier.

Street Address (as it appears on your current phone bill)_____________________________________

City___________________________________   State_____________   Zip Code__________________

*Mailing / Billing Address (if different)________________________________________________

City___________________________________   State_____________   Zip Code__________________
Toll-Free Numbers to be Transferred
I, the undersigned, hereby authorize PowerNet Global Communications to act as my agent for the following toll-free numbers(s):
Toll-Free Number(s) Ring-To Number(s) Current Carrier Switched Dedicated
(____)_____-________ (____)_____-________ ________   ____   ____
(____)_____-________ (____)_____-________ ________   ____   ____
(____)_____-________ (____)_____-________ ________   ____   ____
(____)_____-________ (____)_____-________ ________   ____   ____
Agreement and Waiver
  • The undersigned is not an agent for any third party.
  • The undersigned represents and warrants that they are the exclusive end user/subscriber of the toll-free number(s) listed herein.
  • The undersigned authorizes PNG Telecommunications, Inc. as agent for the appointment of responsible organization for the toll-free number(s) listed herein.

I understand and agree with the above information:

Authorized Customer Signature______________________________________   Date ____/_____/______

Printed Name_______________________________________________________________________

Agent ID: MER-0000001
Rate Code: E49U2
 | Fax this form to 1-888-715-3534 for processing