Telecommunications Billing Responsibility Transfer Form
Complete this form to transfer billing responsibility for telecommunications services from the current account holder to a new responsible party.
Current Account Holder's Full Name
*
First Name
Last Name
Current Account Holder's Email Address
*
example@example.com
Current Account Holder's Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Account Number
*
New Responsible Party's Full Name
*
First Name
Last Name
New Responsible Party's Email Address
*
example@example.com
New Responsible Party's Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Transfer Effective Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Services Covered by Transfer
*
Internet Service
Phone Service
TV Service
Other
Authorization or Additional Remarks
Submit Transfer Request
Should be Empty: