Qwest | Large Business | Authorization to lift a freeze of a preferred service provider(s)

Authorization to lift a freeze of a preferred service provider(s)

For your protection, use of this form requires you to provide an Account Passcode. If you do not currently have an Account Passcode, you can establish one by calling your Sales Representative or 1-800-777-9594. You can also Lift the Freeze of a preferred service provider by:

Calling 1-800-922-1879 and selecting Options 1, 3
Fax or email using a Lift a Freeze Form available from your Sales Representative or at 1-800-777-9594
Sending an email directly to Freezeit@Qwest.com

All orders submitted after 3pm CST will be processed the following business day.

* indicates a required field

Subscriber's Name (Must be exactly as it appears on current bill):*

Subscriber's Address (Must be exactly as it appears on current bill):*

City:*

State:*

Zip:*

Account Passcode:*

The undersigned Subscriber requests Qwest to "lift" the following described freeze(s).

LEF
Local Service
(Dial tone Service)
(Not Available in AZ,MN,NE,NM,IA,MT)

LPIC
Local Long-Distance or Toll Service
(1+ IntraLATA service, Local In-state Long-Distance)

PIC
Long-Distance Service
(1+ InterLATA service, State to State)

Marking the box adjacent to the identified Service(s) is a separate request from, and authorization by, the undersigned Subscriber to Qwest to lift the freeze the Preferred Service Provider of the service(s) for the telephone number(s) below. The Subscriber may choose to remove one, two, or all of the freezes.

Only the telephone numbers listed below are covered by this "Freeze Removal" Authorization.

Subscriber's Main Telephone Number
LEF LPIC PIC

Additional Telephone Numbers
LEF LPIC PIC LEF LPIC PIC LEF LPIC PIC LEF LPIC PIC LEF LPIC PIC LEF LPIC PIC LEF LPIC PIC	LEF LPIC PIC LEF LPIC PIC LEF LPIC PIC LEF LPIC PIC LEF LPIC PIC LEF LPIC PIC LEF LPIC PIC

The phone number(s) listed on this Authorization are listed in my name and/or I am authorized to lift a freeze of the Preferred Service Provider for the phone number(s) set forth above. By pressing the "Submit" button as described below, I am personally signing and dating this form, certifying all of the information on this form, and authorizing Qwest to lift the freeze(s). There is no charge for lifting a freeze.

By clicking the submit button, you are electronically signing and dating this Letter of Authorization, lifting the freezes described above.

Type Name:

Type Title, if applicable:

Type Date (MM/DD/YY):