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Global Crossing

Personal Information

Main Phone You Are Switching ( ) -
(Main number from which you will be making calls)
Physical Address: (No P.O. Boxes, please use the same address as local phone bill.)
First Name
Last Name
Home Address
City
State
Zip
Email Address
Confirm Email
Daytime Phone: ( ) -

Additional Phone Numbers to Switch:   
(We cannot switch cellular phone service.)

2nd Number
 ( ) -
3rd Number
 ( ) -

Payment Options

Option A: Charge my credit card for monthly services
card type Credit Card Number: Expires: (mmyy)
Do not send my a paper invoice. I will view my invoice online. (preserve natural resources)
Option B: Pay by check. (An invoice will be mailed to your billing address)
Social Security Number:
(Example: 555-55-5555. Credit check required for Option B)