Kingdom Long Distance Service Request Form
By submitting this form, Kingdom Long Distance is authorized to act as my agent to notify my local phone company of my
decision to change from my current long distance service to Kingdom Long Distance. I understand that Kingdom
Telephone Company may charge me a fee to switch long distance carriers, and that I may designate only one primary
interexchange carrier for any one telephone number for state-to-state and in-state; and that I may designate only one
primary interexchange carrier for any one telephone number for local toll usage. This Letter of Agency shall remain in
effect until Kingdom Long Distance receives notification from the customer. I certify that I am 18 years of age and that I
have the proper authority to sign this Letter of Agency.

Please enter all the phone numbers for which you would like to change long distance carriers.

Phone *

Phone

Current Carrier * Current Carrier

Please choose a calling plan

Please select any call blocking features you would like applied to your account

International Call Blocking

900 Call Blocking

Bill to Holder Name *

Address *

Address

City

State/Province

Zip/Postal

Country

Billing Phone Number *

Contact Phone Number *

Authorized Signature Name *

Authorized Signature *

Date *

Captcha

Kingdom Long Distance Service Request Form