I Home Phone Order Form
Name ____________________________ Unit ________ - 3033 Townline Road Stevensville, ON L0S 1S1
Telephone ____________________________ Email address____________________________________
Internet Service Provider: Black Creek TV: Other:____________________________
Thank you for your interest in the Black Creek TV Inc. Digital Home Phone offer. Please complete this order form.
Phone Service Options
Please select one of the following plans:
Basic Digital Phone Service $19.95
Basic Phone Service (Ported or New Phone Number, Basic Voicemail, 911 Access, All Phone Features1, Usage Based Canada and US2 Long Distance: rates ¢2.5 to ¢4/ minute)
2) Basic Plus Digital Phone Service $24.95
Basic Phone Service plus 300 minutes of Canada and continental US (excludes Hawaii, Alaska,
Puerto Rico, Yukon, Northwest Territories and Nunavut) Long Distance (Connectivity, Ported or New Phone Number, Basic Voicemail, 911 Access, All Phone Features1, 300 Minutes of Canada and US2 Long Distance and additional minutes for ¢2.5 to ¢4/ minute)
3) Enhanced Digital Phone Service $29.95
Basic Phone Service plus 500 minutes of Canada and continental US (excludes Hawaii, Alaska,
Puerto Rico, Yukon, Northwest Territories and Nunavut) Long Distance (Connectivity, Ported or New Phone Number, Basic Voicemail, 911 Access, All Phone Features1, 500 Minutes of Canada and US2 Long Distance and additional minutes for ¢2.5 to ¢4/ minute)
Installation and setup $30.00
2nd Line for Residential Fax (A phone linked to your computer) $5.00 Monthly
1 All Phone Features include: unlimited local calling, unlimited on-network calls, call waiting, caller ID, call forwarding, do not disturb, three way calling, message waiting indication, call back on busy, and speed dialing.
2 Excludes Hawaii, Alaska, Puerto Rico, Yukon, Northwest Territories and Nunavut
Yes, please sign me up for Black Creek TV home phone service and arrange to port my current phone number to the Black Creek TV digital phone network. DO NOT CALL YOUR PHONE COMPANY TO DISCONNECT SERVICE; THIS OCCURS AUTOMATICALLY WHEN REQUEST TO PORT NUMBER IS COMPLETED. This may take up to 20 business date from when request is submitted.
Date___________________________ Signed _______________________________________
Please also complete the Local Number Portability form on the reverse side of this form as your authorization to port your current phone number to Black Creek TV digital phone network and drop the completed application in the Black Creek TV drop box in the Park Office or send by mail to Black Creek TV PO Box 47018, Mississauga, ON L5K 2R2.
Local Number Portability
LETTER OF AGENCY
Distributel is hereby authorized to act on behalf of:
In the ordering, installation (associated) and administration (associated) of telecommunications related to Local Number Portability (LPN)
This letter supersedes any previous Letter of Agency
Customer Signature___________________________________ Date ____________________
VoIP Phone Number (12 digits, only required if currently a digital phone subscriber) ____________________
Phone Number to be Ported_________________________________
Current Phone Service Provider _______________________________________________
Billing Name (as it appears on your current phone bill) __________________________________________________
Service Address (as it appears on your current phone bill):
Province__________________ Postal Code______________________________
The porting agency also request that you include a copy of your phone company’s recent invoice that shows your name, phone number, and service address associated with the current phone number to be ported – This provides extra assurance that the information provided is correct and authenticated to avoid errors in porting the wrong number.