PREFERRED CARRIER FREEZE

THIS FORM IS TO BE USED FOR CUSTOMERS WISHING TO AUTHORIZE CHOCTAW TELPHONE COMPANY TO IMPOSE A FREEZE ON THEIR INTERLATA AND INTRALATA CARRIER PREFERENCE.

THE UNDERSIGNED HEREBY AUTHORIZES CHOCTAW TELEPHONE COMPANY TO PLACE A FREEZE ON ANY PlC CHANGES TO THE FOLLOWING NUMBERS. ALL NUMBERS MUST BE LISTED BELOW:

A PREFERRED CARRIER FREEZE MEANS THAT THE CARRIER YOU HAVE DESIGNATED FOR INTERLATA AND INTRALATA WILL NOT BE CHANGED BY CHOCTAW TELEPHONE COMPANY YOU REQUEST THAT THE FREEZE BE LIFTED. THIS REQUEST TO RELEASE THE FREEZE MUST COME FROM THE CUSTOMER AND MAY BE WRITTEN OR ORAL. IF AN ORAL REQUEST IS MADE THE TELEPHONE COMPANY WILL REQUIRE EITHER DATE OF BIRTH OR SOCIAL SECURITY NUMBER FOR VERIFICATION, ANY CARRIER CHANGES (PIC) RECEIVED BY THE TELEPHONE COMPANY WILL BE REJECTED UNLESS THIS FREEZE IS ELEASED.

I HAVE READ AND UNDERSTAND THE TERMS OF THE PREFERRED CARRIER FREEZE. I ALSO UNDERSTAND THERE IS NO CHARGE FOR THIS SERVICE.

SIGNATURE: ________________________                          _ DATE:                                     

DATE OF BIRTH OR SOCIAL SECURITY NUMBER: ________________              ___

THIS IS TO REMOVE FREEZE FROM ACCOUNT:

SIGNATURE OF RELEASE:                                                               DATE:                              .