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CenturyLink ° PIC/LPIC 0432
AUTHORIZATION TO CHANGE PREFERRED
TELECOMMUNICATIONS CARRIER
Letter of Agency(LOA): Check all that apply
Long Distance InterLATA/State to State-Qwest Communications Company, LLC DBA
CenturyLink QCC for 1+InterLATA(Including International services)and/or IntraLATA services
(PIC/LPIC 0432)
Bills on Separate Bill cover ALL Local Exchange Providers including QC Local
Select Option to which this applies: Both PIC and LPIC X PIC only❑ LPIC only❑
Selecting the option above is authorization by,the undersigned Subscriber to CenturyLink to change
the preferred carrier for the marked Services.
Subscriber's Name: Weld County Government
Must be exactly as it appears on current bill
Subscriber's Address: 915 10th St
Must be exactly as it appears on current bill
City: Greeley State: CO Zip: 80631
(Use 2 characters)
Subscriber's Main Telephone Number: 970-336-7200/account 70-730031
Only the telephone numbers listed below are covered by this Authorization
Telephone Numbers applicable to change preferred carrier:
Telephone Telephone Telephone Telephone
Number Number Number Number
970-346-7666
970-346-7667
970-346-7668
970-346-7683
970-353-3800
970-353-5215
970-346-6940
BMG 0432 LOA 2/2012 Page 1
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Telephone Number Range(s): (format NPA-NXX-XXXX TO XXXX)
Telephone Numbers Telephone Numbers Telephone Numbers
TO TO TO
TO TO TO
TO TO TO
TO TO TO
TO TO TO
TO TO TO
TO TO TO
TO TO TO
TO TO TO
TO TO TO
TO TO TO
TO TO TO
TO TO TO
TO TO TO
TO TO TO
TO TO TO
TO TO TO
TO TO TO
TO TO TO
TO TO TO
TO TO TO
TO TO TO
O Check here if a separate page listing other associated telephone numbers is attached.
I understand that my local exchange carrier(LEC)may charge a fee to change Long Distance carriers and
that I may contact my LEC to determine the specific charges. I represent that I have the authority to change
communications carriers for each of the numbers identified above. I understand that I may designate only
one telecommunications carrier as my local exchange, intrastate or intraLATA, interstate or interLATA,
and international preferred interexchange carrier for any one telephone number. With this understanding, I
select CenturyLink to provide the communications service types indicated above for each of the telephone
numbers listed above.
Name of Person Authorized to Act on Behalf of the Company.
Signature: Title: Chair, Board of Weld County
C
Commissioners
Printed Signature: 4 an P. Conway Date(mm/dd/yy): SEP 0 5 Z012
BMG 0432 LOA 2/2012 Page 2
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