PHONE SERVICE AUTHORIZATION AND LETTER OF AGENCY (LOA)

I hereby authorize Central Oregon Internet to act as my agent in all matters relating to the provisioning of phone service. I understand that, by signing this Letter of Agency (LOA), Central Oregon Internet may make inquiries about my bill, and/or place order(s) with Qwest on my behalf for changing or provisioning my phone services.

I represent that I have the authority to for each of the numbers identified on this form and that I am at least eighteen (18) years old.

SUBSCRIBER NAME:
ADDRESS:

CITY:		ZIP:
AUTHORIZED NAME*:
DATE:	Jun 10, 2026
PHONE NUMBER:
* The person or company in whose name telephone service is provided. Usually, but not necessarily, this is the same as the subscriber.
Coinet Verification Code**:

** The verification code is a unique code issued by Coinet to each subscriber. It indicates that you, and only you, have submitted this form. If you do have a code please contact Coinet.