Instructions:
    Fill out the form with as much information as possible.
    Fields marked with an asterisk (*) are required.

Personal Information

First Name* Last Name*
Address* APT.
City* State*Zip*
E-mail Address* Contact Number Extenstion (if any)
Last 4 digits of your Social Security Number*

Service Information

If you have more than 6 phone numbers you would like to switch to Euro Connect, please call (800) 396-6916 after completing this form, to add them to your account.
Main Line* Additional Line Additional Line
Additional Line Additional Line Additional Line
Services*    
e-Directe-Dial e-Travel

Confirmation

Letter of Agency


I have read and understood the Letter of Agency and agree with the Terms and Conditions of the services selected.

I am over 18 years old and authorized to make changes to the phone lines listed above.