Please indicate the service or plan you would like to order below.


Peak 1 Rate plan
Calling Card service
Straight Rate plan
Personal 800 service
Calling Card and Personal 800 service



Please enroll me in Peak Communication Inc.'s program. I certify that I am of at least 18 years of age and that I have the authority to change the long distance, local toll service and/or add a personal 800# to the telephone line listed below. I understand that Peak Communications will act as the agent initiating the change by contacting my local phone company and that I can only have one long distance carrier at any time for any one telephone number. I also understand that the local phone company may charge me a fee for the change.

If you have more than one phone line then please indicate the appropriate bill to numbers below.


I am over 18 years old - Yes: No:

Line 1: bill to number:
Line 2: bill to number:
Line 3: bill to number:
Line 4: bill to number:
Line 5: bill to number:
Name:
Address:
City: State: Zip:
E-Mail: