Please fill out online. If you wish you may also print out and fax to 1-219-996-2205 or call 1-866-996-LONG.
General Information
Date
Customer or Business Name
Street Address
City
State
Zip
Email
Billing Address (If Different)
Calling Plans -
Rates 24 hours a day 7 days a week for the contiguous USA
EZ 10 - 10 cents/minute $4.95 Montly Fee
EZ Basic - 12 cents/minute
Enhanced Calling Cards
Quantity Desired
PIN # Desired (4 Digits)
Telephone Numbers
Main telephone number (as it appears on telephone bill)
All other numbers billed to this account.
(800, 888, 877) Toll Free Numbers
New 800# (Check here)
Next Available Number
I would like to request this number:
Existing 800# (Check here)
Please click here and complete the form to change your toll free carrier.
Existing 800# (Who is current Carrier?)
800#
Bill to
800#
Bill to
800#
Bill to
Referral -
If you were referred to NetNITCO Long Distance by someone, please include thier name and address
Name
Address
Agreement
1.You agree that the electronic signature and records generated from clicking on the "Submit Order Now" button authorizes NetNITCO Long Distance to act as agent in all matters relating to the primary interexchange carrier changes for the telephone numbers listed on your order form. You also agree that NetNITCO Long Distance shall become your long distance telephone company and your current long distance carrier will no longer serve you. In addition, you agree that your local telephone company may charge a fee to switch to NetNITCO Long Distance. You further agree that you may designate only one long distance carrier for any one-telephone number, and therefore revoke any previous appointments or selections concerning the telephone numbers listed in your order form. 2.You may obtain an electronic or paper copy of your electronic consent and information given by emailing a request to sales@netnitcold.com. 3.You may also call NetNITCO LD to receive a paper service agreement. 4.You'll receive a detailed copy of your order and all the information you just submitted to the email address you provided.
Agree -
Disagree
Printable Version
