Pacific Internet - Ukiah, California

Provider Change Authorization

Fusion Change of Provider Letter of Authorization

This form is required to change local exchange providers (required for Fusion Service).

If you would prefer to print and mail or fax us the form, please use this form instead.

I hereby select Pacific Internet, an agent for Sonic Telecom, LLC, to be my local exchange provider and to act as our Agent in dealings with our current local exchange telephone company. Pacific Internet may place orders for new services and changes to existing services. This authorization covers the following locations and billing telephone numbers and shall remain in effect until further written notice is provided. I understand that I can have only one local service provider for any one telephone number.

Customer Billing Name:
Customer Billing Address:
Customer Service Address:
Name of Authorized Individual:
Contact Number:
Contact Email:
Phone number(s) where Fusion service will be activated (including area code):

By submitting this form, I am authorizing Pacific Internet, an agent for Sonic Telecom, LLC, to become my new telephone service provider in place of my current provider for the provision of local and long distance telephone services. I authorize Pacific Internet to act as my agent to make this change happen. I understand that if I wish to return to my current local telephone company, I may be required to pay a reconnection charge to that company. I also understand that my new local telephone company may have different rates and charges than my current telephone company, and that by signing below I indicate that I understand those differences (if any) and am willing to be billed accordingly. I authorize Pacific Internet to provide local and long distance service to my telephone number(s) listed above, and no others.

I certify that I have read and understand the Letter of Authorization. I further certify that I am at least eighteen years of age, and that I am authorized to change telephone companies for services to the telephone numbers listed above.

Signature: (please type your full name)