Log #: ______

AT&T 13-State[1]Wholesale Transfer ofTelephone Service

THIS FORM IS A LEGAL DOCUMENT, ANY ALTERATION TO THIS FORM PROHIBITS AT&T 13-STATE FROM PROCEEDING WITH YOUR REQUEST.

AT&T13-State: Please transfer the existing retail public pay phone lines identified on

the associated list billed to ______located at

Name of Present customer

______

Present Customer Address

and reassign telephone number(s) ______, effective

______to ______, the new

Bill Month/Year Name of New Customer

customer at that location.

I authorize AT&T 13-State to release details on billing (current and past due) and the services being provided on the above account to the new customer. Please refund/apply/transfer any deposits plus interest to the undersigned/new customer's account.

Present Customer Name Printed ______

Present Customer Signature ______Date ______

TO THE NEW CUSTOMER: BY SIGNING THIS AGREEMENT YOU AGREE TO PAY ANY CHARGES LEFT UNPAID BY THE PRESENT CUSTOMER.

In consideration of AT&T 13-State's reassigning the above telephone number, I agree to pay AT&T 13-State any charges left unpaid for telephone service already furnished. I agree to release any said number upon the request of AT&T 13-State, and to indemnify and save harmless said Company against any claim or suit because of the assignment of such number to me. I also understand that I have the right to inquire about the current and past due charges on said telephone number, before signing this agreement.

In accordance with the applicable state tariffs, there may be a one-time charge to transfer the account.However, if changes are made tothe service (for example, from a “Coin” or “Smart” line service to a basic or “dumb” access line service or vice versa) at the time of the transfer, the service is considered new, and therefore subject to applicable order and installation charges.

New Customer Name Printed ______

New Customer Signature ______Date ______

New Customer Tax ID or SS Number______

New Customer Address ______

New Customer Contact Telephone Number______

New Customer - Note Any Changes to Existing Service______

______

Return signed form to:

AT&T Arkansas, California, Illinois, Indiana, Kansas, Michigan, Missouri, Nevada, Ohio, Oklahoma, Texas, and Wisconsin:

Richardson Access Service Center

Payphone Group

1410 Renner Road, Ste. 150

Richardson, Texas 75082

Telephone Number: 800-924-3666

Fax Number: 800-805-3555

AT&T Connecticut:

AT&T Connecticut PSP Center

5 West Service Road, 2nd Floor

Hartford, CT 06120

Telephone Number: 888-870-7638

Fax Number: 860-560-0011

[1] AT&T 13-State means Illinois Bell Telephone Company, d/b/a AT&T Illinois; Indiana Bell Telephone Company, Incorporated, d/b/a AT&T Indiana; Michigan Bell Telephone Company, d/b/a AT&T Michigan; Nevada Bell Telephone Company, d/b/a AT&T Nevada; The Ohio Bell Telephone Company, d/b/a AT&T Ohio; Pacific Bell Telephone Company, d/b/a AT&T California; The Southern New England Telephone Company, d/b/a AT&T Connecticut; Southwestern Bell Telephone Company, doing business in Arkansas as AT&T Arkansas, in Kansas as AT&T Kansas, in Missouri as AT&T Missouri, in Oklahoma as AT&T Oklahoma, and in Texas as AT&T Texas; and Wisconsin Bell, Inc., d/b/a AT&T Wisconsin.