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Service Modification Form

REQUEST FOR SERVICE MODIFICATION

Subscriber's Name / Business Name

Globelines Number

Address

MODIFICATIONS
( Please check the corresponding box of the service required )

Supplementary Features

Caller ID Voice Mail IDD Caller ID Package

Call Waiting Three-way Calling NDD (Caller ID & Any Feature Except Voice Mail & Call Wait
Call Forwarding Last Call Memory Phone Lock Call Waiting Package
(Call Waiting & Any Feature Except Caller ID & Voice M

Note : 1) Each feature comes with corresponding Monthly Service Fee.

2) Voice Mail and Call Waiting cannot be subscribed simultaneously.

Modify / Cease Product Selection

Delete Services Add Services

Change Globelines Number

New Billing Address to : (Please attach proofs)

Rm/Flr. No. & Bldg. Name (No. and Street Name) (District/Barrio)

(Town & City) (Province) (Zip Code)

New Owner to : (Please attach new proofs)

New Location for Line Transfer: Desired Date for Line Transfer:

Rm/Flr. No. & Bldg. Name (No. and Street Name) (District/Barrio)

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(Town & City) (Province) (Zip Code)

Miscellaneous / Remarks

I am fully aware and undertake to pay any charges arising from the above charges by affixing my signature hereunder.

Admin Fees : P __________________

Subscriber/ Service Charge : P __________________
Authorized Representative's Signature P __________________
TOTAL DUE : P __________________
Date

Approved by Account No. Date

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ATION

Date
Order No.
Reference No.

equired )

Caller ID Package
Caller ID & Any Feature Except Voice Mail & Call Waiting)
Call Waiting Package
Call Waiting & Any Feature Except Caller ID & Voice Mail)

Add Services

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ges by affixing my signature hereunder.

Cashier : ______________
O.R. No : ______________

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