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Data Vendor-Company Name Vendor Code <br /> ___ -- —__------__._._______.. ._.---_... .____.___.. <br /> Name _ _ Title <br /> ___, _.___ _ .__-- ---_----.--__,_ ._�.__._. �..___�_ __ �,� <br /> Phone Cell <br /> -------------_..._----_... ___-- ---------._._�_-- _ _—__. —_______._�._._......_—___� <br /> Email Fax <br /> _ ___..__._ _._.._- ------ --_..__� _�_ --_� <br /> Auth Level RWA {cirle appropriate authorization level) <br /> Duratiai 7ercn ot Convact (cirle appropriate duration) <br /> This letter of authorization does not preciude me or my company from placing orders,handling billing disputes and/or <br /> trouble tidcets direcdy with TelePacific Communications on mylour beh�f. <br /> Account Number: <br /> _ _� _�._---__--- ------- <br /> CustomerlBusineas Name: CI�/Of f28ClWOOd Ci�/ <br /> Billing Address: 1017 Middlefield Rd <br /> � _ _ _ <br /> City: State: Zip: 94063 <br /> The undersigned has read the foregoing and represents that he/she is authorized to act on behalf of the Customer. <br /> Printed Name: ��c-� /�uL�--�� ,,,� <br /> Title: <br /> Authorized Signature: <br /> To facilitate processing of these forms,they may be retumed in the following ways: m� <br /> ■ By mail: TelePacific Communications,Attn:Customer Care,3485 Brookside Dr.Suite 102,Stockton,CA 95219 <br /> ■ By e-mail: Scan sig�ed documents and send to: customerservicelrDteleoacific.net <br /> ■ Byfax: 866-891-2088 <br /> !�Initial <br /> v120409 Page 2 of 2 <br /> ATTY/AGR.2015.186Relepacific Telephone Lines <br />