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Please print this form from your browser, complete it,
then fax it to 1 800 576-1810.

  We need ALL the following information because we want to
write an accurate proposal for your company the first time.

Company Name ____________________________________

Contact Person __________________________________

Address _________________________________________

City _____________________ State ____ Zip________

Phone _________________________ Fax __________________________

Email Address ________________________________________________

How many locations are there? ___________

Do you currently have T-1 dedicated service? _________

     If "yes," what are your monthly recurring charges? _________

     Please list all the area codes and local exchange prefixes
     associated with this service or planned service:





Do you currently use "point-to-point" private lines? ________

     If "yes," what are your monthly recurring charges? ________

     If "yes," how is this service used in your organization?


     Please list all the area codes and local exchange prefixes
     associated with this service or planned service:





How many minutes of interstate outbound traffic do you use?      ____________

How many minutes of interstate inbound (8XX) traffic do you use? ____________

How many minutes of intrastate outbound traffic do you use?      ____________

How many minutes of intrastate inbound (8XX) traffic do you use? ____________

Do you have any 56K private lines or frame relay service?__________








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Our proposal program can show you all the rates from our different
carriers. It can also compute a saving analysis. To compute the monthly
and annual savings analysis we need to know what you are currently
paying per minute for each type of service. If you will provide your
current rates then our savings analysis will be accurate.

Interstate outbound switched rate       $______ 
Interstate inbound (8XX) switched rate  $______
Interstate outbound dedicated rate      $______
Interstate inbound (8XX) dedicated rate $______

Intrastate outbound switched rate       $______
Intrastate inbound (8XX) switched rate  $______
Intrastate outbound dedicated rate      $______ 
Intrastate inbound (8XX) dedicated rate $______

Please call 1 800.576.1810 anytime with your questions, comments and requests.