Full Name (exactly as listed with current carrier)* Company Name (exactly as listed with current carrier)* Contact Number Service Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest 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 ###-###-####Signature Reset signature Signature locked. Reset to sign again Captcha