Toll Free Order Form

Toll Free - Order Form

Please enter the information exactly as it appears on your phone bill
( * indicates required item)

	Your Full Name	*
	Address Line 1	*
	Address Line 2
	Apartment #
	City	*
	State	*
	Zip	*

	Social Security/EIN Number	*
	Email Address	*
	Re-type Email Address	*
	Main Telephone Number	*
	Additional Contact Number

Toll Free
Contact us if you have more than 4 new or existing numbers
or if you have specific new/vanity number requests

ADD toll free number(s):

Ring to:

Transfer EXISTING toll free numbers

TollFree Number:

Ring to:

TollFree Number:

Ring to:

TollFree Number:

Ring to:

TollFree Number:

Ring to:

Billing:

Paperless Billing information online and via email
Direct Bill Receive a paper invoice each month ($2.99 Billing Fee if monthly usage is under $20)

Please enter your credit card information below

Credit Card

Card Number

Credit Card ID How to find

Expiration

Check here if your credit card billing address is the same as above. Otherwise complete information below.

Name on Card

Address Line 1

Address Line 2

City

State

Zip

I have read, understood and agree to the Terms of Service and authorize Mils Research Inc. to switch my long distance provider, including interstate, intrastate, international and intralata/local toll calling.

I am at least 18 years of age *

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