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Long Distance PIC Freeze
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Please complete the form below and return it to Grand Mound Cooperative Telephone Association.
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Subscriber's Billing Name
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______________________________
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Subscriber's Billing Address
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______________________________
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City-State-Zip code
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______________________________
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Telephone Numbers to be Covered by Freeze
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______________________________
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______________________________
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Please Circle the Service you Wish to have Frozen:
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Intralata
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Interlata
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Both-Inter & Intra
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Signature
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______________________________
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Date
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______________________________
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