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TelePacif�c <br /> C O M M d N/L A T/O N f <br /> r�. <br /> AUTHORIZATION FOR THIRD-PARTY ACCOUNT <br /> REPRESENTATION: <br /> TO OBTAIN CUSTOMER'S SERVICE RECORDS, BILLING INFORMATION <br /> AND CREDIT INFORMATION <br /> I, hereby authorize the following"Agency(ies)"(AgenWendor/Other Third Party)and its <br /> representatives to obtain my or my company's(hereinafter"Customer")customer service records <br /> and billing information, as well as credit information,from U.S. TelePacific Corp., Mpower <br /> Communications Corp. and/or Arrival Communications, Inc., all d/b/a TelePacific <br /> Communications, as necessary. I am requesting that TelePacific Communications interface <br /> directly with the Agency and its representatives in providing service records, responding to <br /> requests for changes in service, billing disputes and/or trouble tickets, for purposes of assisting <br /> Customer as noted below. I have indicated the level and duration of this authorization for each <br /> "agent"by selecting from the following: <br /> Authority Levels(choose one that applies): <br /> R/VN/A:(Read/Write/All)This"agenY has full authority to request information and place orders on all aspects <br /> of the account including bill usage and netrnrork configuration. <br /> F2/W/B:(Read/VVrite/Bi1D This"agenY'has the authority to ask questions abaut billing issues and request bill <br /> related changes on the acxount such as the billing address. <br /> R/W/O: (Read/VVrite/Orders):This"agenY'can receive information about the network configuration on an <br /> account including line type,count,and physical and data configuration.This contact is authorized to place <br /> orders on the account inGuding reconfigures,moves,adds,changes, new locations,etc. <br /> R/O: (Read/Only1 This type of contact is allowed to request and receive information regarding bills, network <br /> configuration, and orders,but is not authorized to make changes on acxounts or orders. <br /> R/T: tReadlTrouble)This authority level is allowed to report trouble on accounts, receive network <br /> configuration information in support of resolving trouble on the acxount.They are not authorized to receive <br /> information about on-line customer acoess system passwords or place orders for accourrt changes. <br /> Duration of Authorization(choose one that applies): <br /> This Order/Installation only <br /> Term of contract and extensions with a TelePacific company or until TelePac�c is otherwise <br /> notified in writing <br /> AGENT CONTACT-COMPANY NAME AGENT CODE <br /> Name Title <br /> Phone Cell <br /> Email Fax <br /> Authority Level RWA RWB RWO RO RT (cirGe appropriate authorization level) <br /> Duration This Installation Only Term of Contrad (arGe appropriate duration) <br /> VOICE VENDOR-COMPANY NAME VENDOR CODE <br /> Name Title <br /> Phone Ce11 <br /> Email Fax <br /> Authority Level RWA RWB RWO RO RT (arde appropriate authorization level) <br /> Duration This Installation Only Term of Contract (cirde appropriate duration) <br /> DATA VENDOR-COMPANY NAME VENDOR CODE <br /> Name Title <br /> �12p4p9 page 1 of2 <br />