Nationwide Calling*
Letter of Agency
Name
Address
City
State
Zip______________
E-mail Address
I understand that by signing this form below, I authorize Tele-Media Solutions to assign my Inter-Exchange
calls to Tele-Media Solutions’ PIC1 for the following types of calls: Interstate Intrastate
Further, I authorize the Tele-Media Solutions’ PIC to be assigned to the following numbers:
Phone #1 (
) ____-______
Phone #2 (
) ____-______
Phone #3 (
) ____-______
Additionally, I understand that my application may be subject to credit review. Tele-Media Solutions may
use any information obtained from this service application or credit reporting agencies, to determine credit
worthiness.
Pick your Plan / Services:
60 Anytime Minutes - 24/7 included in 3-Play Basic and 2-Play Broadband Basic Packages
(Long-Distance calls placed beyond the 60 minute calling plan will be charged at the standard 5.9 cents / minute.)
120 Anytime Minutes - 24/7 included in 3-Play and 2-Play Complete and Ultimate Packages
(Long-Distance calls placed beyond the 120 minute calling plan will be charged at the standard 5.9 cents / minute.)
500 Anytime Minutes - 24/7 for $27.50 per month
(Long-Distance calls placed beyond the 500 minute calling plan will be charged at the standard 5.9 cents / minute.)
5.9 cents / minute - 24 /7
Conference Calling - 10 cents / minute
800 Toll Free Service - 6.5 cents / minute
Yes to PIC Freeze - No charge
(This prevents any change in your long distance carrier without your authorization)
Yes No to Allow International Calling
* Calls to / from contiguous 48 states only. Calls to / from Alaska, Hawaii, Guam, Puerto Rico and U.S. Virgin Island rated at 11
cents per minute.
Signature____________________________________________ Date
The terms and conditions governing the provision of our interstate, intrastate and international long distance services are set forth
in our Terms and Conditions of Service document which is available for your inspection at our business office located at 105 E
Railroad Street, Pekin, IN, during normal business hours (8:30 a.m. to 4:30 p.m., Monday - Friday). This information is also
available on our website - www.tele-mediasolutions.coop. Your access and use of our interstate, intrastate or international long
distance service represents acceptance of the terms and conditions set forth in the Terms and Conditions of Service document.
We will provide you with advance notification of changes in the document through either a bill insert or direct mail.
1
A PIC (Presubscribed Interexchange Carrier) is the code assigned to an inter-exchange carrier to route interstate and intrastate
long-distance telephone calls.