Change Of Name Or Ownership Change Form printable pdf download

NVC-1000-50-01

Change of Ownership & Customer Credit Application

July 1, 2008: Revision I

Page 1 of 3

Change of Name or Ownership Change Form

Attention Customer – Contact NuVox at 1-800-600-5050, Option #3 for processing. This form cannot be changed or altered.

Failure to complete and return this form within 10 business days could result in loss of service. A Change of Ownership Request Form must be

submitted for each location.

Section I - Former Responsible Party

I hereby state that I have the legal authority to request NuVox Communications (“NuVox”) to release me from all financial and contractual

obligations regarding my local exchange, long distance, toll free and/or Internet service(s) as specified in any and all Service Agreement Terms

and Conditions. I warrant that I have the legal authority to and have made a conditional agreement to transfer the covered service(s) for the

below account to the individual / company listed in Section II.

The Former Responsible party is still considered the owner of the account until such time as this order is accepted and completed within NuVox

Communications’ billing system, and is responsible for all charges until NuVox Communications’ billing system reflects the change. At such

time as the billing systems reflects the change, the new responsible party will assume the current Account number(s) and will be responsible for

payment of unpaid charges for past or future service (either billed or unbilled) provided by NuVox to Former Responsible Party.

Customer Account Number: __________________ Company Name: ______________________________________________________

Number(s):

__________________________

Primary Authorizing Contact Name* (Printed): ___________________________________________ Title: ________________________

*Name Must Match NuVox Records

Primary Authorizing Contact Signature: _______________________________________________

Date: ________________________

Section II – New Responsible Party

I hereby warrant that I have full legal authority to accept the transfer of service(s) (including any applicable service agreement and contract term)

and I hereby accept such Terms and Conditions. I understand that the service will not be transferred to me until such time that I have satisfied all

of the Terms and Conditions regarding the service(s) and completed all required documentation. I understand that I may NOT request any

changes to the service(s) until after the effective change date and that any accumulated Rollover Long Distance minutes will not be transferred

with the other services. I understand that I am responsible for payment of unpaid charges for past service (either billed or unbilled) provided by

NuVox to Former Responsible Party. I understand that I am responsible for all future charges for service provided by NuVox to New Responsible

Party.

______

Number Abandonment - I hereby warrant that I have made a good faith effort to locate the transferring/releasing party in order to

complete this change of responsibility contract and have been unsuccessful. Therefore, the telephone numbers listed in the transfer or releasing

party name are in effect abandoned. I accept responsibility for these abandoned telephone numbers and I hereby accept Terms and Conditions

described in Section I of this document. Furthermore, I accept responsibility for the existing NuVox Communications account number and all past

due, current and future charges against this account.

With these agreements from both the New and Former Responsible Parties, NuVox assents to the assignment of Former Responsible Party’s

Terms and Conditions to New Responsible Party.

New Company Name: ____________________________________________________________ Fed ID Number: __________________

Physical Address: __________________________________________ Billing Address: _______________________________________

Primary Authorized Contact Name (Printed): ________________________________________________ Title: _____________________

Primary Authorizing Contact Signature: ______________________________________________________ Date: ___________________

Primary Authorizing Contact Email address: ____________________________________________Contact TN: ____________________

My initials in the space(s) below indicate that I authorize Nuvox Communications to change the following:

Outbound Caller ID ______

Directory Listing ______

Directory Assistance ______ Authorized Contacts _______

If any of the above options are initialed, please provide a detailed list for each type of change requested.

** PLEASE NOTE: FORM MUST BE COMPLETED IN IT’S ENTIRETY BEFORE PROCESSING CAN BEGIN **

Change Of Name Or Ownership Change Form

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