Transfer of Service Agreement
I hereby release the use of the telephone number(s) and/or broadband circuit(s):
__________________________________________________________________
to Lake Region Technology & Communications.
_____________________________ ____________
“Current Customer’s Signature” Date
____________________________________ ___________________________________________
Current Customer’s Name (Please Print) Current Customer’s Tax ID
____________________________________
Account Name
I hereby assume all charges outstanding on the telephone and/or broadband services for account
, billed or unbilled, including any additional charges for white page directory
listings. Directory advertising includes advertising associated with the telephone number in the white pages
of the current issue of the directory as well as for subsequent issues as described in any oral or written
application for white pages advertising by the present customer.
If the current customer does not sign to release the above mentioned telephone and/or broadband
service(s), the undersigned agrees to voluntarily release said number to any other person with a superior
right to its use who may assert such right at a later date, and the undersigned further agrees to hold and
save Lake Region harmless from any and all liability to such person with superior rights to the use of said
number which arise as a result of the Transfer Agreement.
_____________________________ ________________________________
“New Customer’s Signature” Date
_____________________________ ________________________________
New Customer’s Name (Please Print) New Customer’s Tax ID
____________________________________ ________________________________________
New Account Name New Mailing Address
_____________________________ ________________________________
New Contact Phone Number New Billing Email Address
