Full Name (exactly as listed with current carrier)*Company Name (exactly as listed with current carrier)*Contact NumberService Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Enter Suite number in Address Line 2List Affected Toll-Free Number(s) Below:*Toll Free NumberRing to Number: (if no POTS, please put “N/A”)Current Carrier/Provider Please list the phone numbers you would like to port in the following format ###-###-####SignatureCaptcha