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Northeast Missouri Long Distance

P.O. Box 98

Green City, MO 63545

Complete the Boxes Above, Print, Sign and Mail. Call 1-800-224-6182 if you have questions.

I hereby authorize and designate Northeast Missouri Long Distance, L.L.C. to act as my agent for the purpose of submission to Northeast Missouri Rural Telephone Company and/or Modern Telecommunications Company of an order or orders to change my preferred long distance company from my current provider to Northeast Missouri Long Distance, L.L.C. for the telephone number/s indicated above. The change or changes I am authorizing Northeast Missouri Long Distance, L.L. C. to submit are for the service or services indicated by my signature or signatures below.

IntraLATA and InterLATA Long Distance

Missouri is divided into major long distance calling areas called LATAs (local access and transport areas). Calls to a place within the same LATA are called intraLATA calls. Your intraLATA calls would include calls to the 816, 660, and 913 metropolitan area of Kansas City. Calls to a place outside of a LATA including both intrastate and interstate calls are called interLATA calls. Additionally, if Northeast Missouri Long Distance, L.L.C. is designated as a customer’s interLATA carrier, Northeast Missouri Long Distance, L.L.C. will also automatically handle direct dialed international calls.

I understand that FCC rules require that I separately authorize preferred long distance companies for inter and intraLATA services. If I sign only once, for either intraLATA alone or interLATA alone, I understand that only the single service will be affected by this letter of authorization. If I sign on both lines, I understand that both services will be affected by this letter of authorization. I also understand that each change, including separate charges for interLATA and intraLATA, may involve a charge from Northeast Missouri Rural Telephone Company and/or Modern Telecommunications Company for executing the change.

Rates, Terms and Conditions of Service

The rates, terms and conditions governing the provision of our Interstate and International long distance services are set forth in our Rates, Terms and Conditions of Service document which will be available for your inspection at our business office located at 718 South West Street, Green City, Missouri during normal business hours (8:00 a.m. to 4:30 p.m). This information will also be available on our website www.nemr.net/neld.html

Your access and use of our Interstate and International long distance service, represents acceptance of the rates, terms and conditions set forth in the Rates, 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.

Please change my IntraLATA long distance carrier from my current long distance company to Northeast Missouri Long Distance, L.L.C. My signature also authorizes the removal of a PIC freeze, if I have one in place.

____________________________________ _________________________________

Signature Date

Please change my InterLATA long distance carrier from my current long distance company to Northeast Missouri Long Distance, L.L.C. My signature also authorizes the removal of a PIC Freeze, if I have one in place.

____________________________________ _________________________________

Signature Date

PIC FREEZE NOTICE

In order to comply with the Missouri Public Service Commission’s Chapter 33 requirements, I am notifying Northeast Missouri Rural Telephone Company/Modern Telecommunications in writing of my desire to have a PIC freeze added to my telephone service.

This authorizes Northeast Missouri Rural Telephone Company/Modern Telecommunications to place a PIC freeze on my telephone number(s) I have listed below. I understand that I will be unable to make a change in my long distance service unless I either lift the PIC freeze or unless I personally notify Northeast Missouri Rural Telephone Company/Modern Telecommunications of my intent to change my long distance service. I understand that this PIC freeze helps to protect me from my long distance service being changed without my permission. The request to remove the PIC freeze must be either in writing or by a telephone call placed from my telephone service. I understand that this is a free service.

Name ____________________________________________________________

Address ____________________________________________________________

Box, Street or RR City State Zip Code

Please add a PIC freeze to my telephone service(s) at: 660-____________________

660-____________________

The PIC freeze is to be applied to the following services:

_____ Both Interstate and Intrastate long distance service

_____ Intrastate long distance service only

_____ Interstate long distance service only

SIGNATURE _____________________________________ Date _________________

Name:	First Phone:
Company:	Second Phone:
Address:	Third Phone:
City, ST Zip:	Fourth Phone: