What types of Long Distance services do you need?

(check all that apply)

Is your current Long Distance carrier?

Select one... Currently No Long distance AT & T Cable & Wireless Qwest MCI/Worldcom Sprint Other Provider Not Listed

Do you have a term commitment with this carrier?

Select One... No Commitment Commitment Under 6 months Commitment Over 6 Months Not Sure

Your monthly long distance charges:

Select One... Currently No Long Distance Under $100 $100-$300 $301-$500 $501-$2500 Over $2500

Will you need international conference calling?

Select One... Never Sometimes Every Call Not Sure

When are you looking to start using the Services?

ASAP within 1 day within 2 days within 1 week within 1 month

What additional services will you need?

(check all that apply)

Please describe in brief any additional requirement you may have:

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