Contact Information
Company Name (optional):
First Name:   Last Name:
Date of Birth: - -
(mm-dd-yyyy) 		  Email:
Name of old carrier:   Daytime Contact Number:

Physical Address
Address:
City: State: Zip:

Mailing Address (if different from above)
Address:
City: State: Zip:


Method of Payment

The default method of payment will be by Check or Money Order. You will receive your invoice via mail.

Additional Services Requested

PRIMUS Local Toll Service

Yes, please switch me to PRIMUS local long distance
 No, please don't switch me



PRIMUS 800 Toll-Free Number

Existing Tollfree Numbers - If you have existing tollfree number(s) that you would like to move to PRIMUS please complete the attached form and fax it along with a recent invoice that shows your name and the existing tollfree number(s) to 1-800-860-4820. [To read this attached document, you need Adobe Acrobat Reader.]

Yes, I would like a personal toll free number

    Ring to Number: --
No, I wouldn't like a personal toll free number


PRIMUS' Calling Card Plan

Yes, I would like a calling card
 No, I wouldn't like a calling card

Telephone Number(s) To Be Registered:

Primary Phone 1 ( )    -  Phone Number 2 ( )    - 
Phone Number 3 ( )    -  Phone Number 4 ( )    - 

Click here if you need more phone lines


Internet Letter of Authorization Language

By clicking the "Place Order" button below, I submit this order designating the PRIMUS division of Primus Telecommunications, Inc. ("PRIMUS") to act as my agent for purposes of switching my long distance service and/or local toll service to PRIMUS. I consent to the use of this electronic letter of authorization to record my desire to switch. I acknowledge that I have the necessary software and hardware to submit this form electronically to PRIMUS, and I understand that I may withdraw my consent to use electronic records at any time by contacting PRIMUS at 1-800-338-0225 .

By submitting this order, I authorize PRIMUS to notify my local telephone company of my decision to switch to PRIMUS as my primary long distance company and/or my carrier for local toll calls. I understand that I may designate only one preferred carrier for each type of long distance service for any telephone number. By submitting this order, I confirm that I am at least 18 years of age and that I am authorized to change telecommunications services for the phone number(s) to be changed. I agree to take the affirmative steps needed to make these switches. I understand that my local telephone company may charge me a fee to switch my services to PRIMUS, and that I may consult a representative of PRIMUS about whether a fee applies to my switch. I understand that I may call PRIMUS at 1-800-338-0225 in order to provide oral verification of my desire to change long distance providers. By clicking the "Place Order" button I certify that I have read and agree to this letter of authorization.

You may have carrier choice protection (also known as a "PIC freeze") on your phone number(s), which prevents your phone service from being switched to another company without your authorization. If so, you will need to contact your local telephone company and request that it be removed. Otherwise, your request to switch to PRIMUS will not be successful.

For a printout of this page use the "print" button on your browser, or call PRIMUS at 1-800-338-0225 for a copy at no charge.



  Additional Phone lines

  Phone Number 5 ( )    -  Phone Number 6 ( )    - 
  Phone Number 7 ( )    -  Phone Number 8 ( )    - 
  Phone Number 9 ( )    -  Phone Number 10 ( )    - 
  Phone Number 11 ( )    -  Phone Number 12 ( )    - 
  Phone Number 13 ( )    -  Phone Number 14 ( )    - 
  Phone Number 15 ( )    -  Phone Number 16 ( )    - 
  Phone Number 17 ( )    -  Phone Number 18 ( )    - 
  Phone Number 19 ( )    -  Phone Number 20 ( )    - 

Continue >>
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