Business Phone Letter of Authorization

I hereby authorize Midwest Energy & Communications and its partners to view, make additions, changes and deletions on my account associated with the business telephone numbers listed on this form.

Name as it Appears on Current Telephone Bill *

Current Provider

Current Provider Account Number

PIN/Password

Primary Business Phone Number (no spaces or dashes) *

Additional Business Phone Numbers (One per line)

Your Name *

Title

Organization *

Service Address 1

Address 2

City *

State * - Select a State - Alabama Alaska Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip Code *

Contact Phone Number *

Email *

Upload PDF of Current Phone Bill