ADSL Information Change Form

Your Current Information:
Email Address:		Phone Number:
Name:		City/Town:
Address:		Postal Code:
Change Information
Will your Phone Number remain the same? Yes No
Will your Address remain the same? Yes No
Have you or will you be changing Telephone Providers? Yes No
If yes who is your new Phone Provider?		Circuit Number: (If Dryloop enter "DRYLOOP")
Please provide the new information for you telephone number or address, the information should match your phone bill.
Name:		Phone Number:
Address:		Postal Code:
City/Town:		Activation Date:
Contact Name:		Contact Number:
Name of Business (if Applicable):

Please note:

We cannot move the service until the telephone number has been activated at the new location.
Please ask your telephone provider for your move order number (this will facilitate the process).
There may be a delay in activation (usually no more then 7 days) due to third party telco provider issues that are beyond the control of Sentex. During such time, Sentex dial-up is available to you at no charge.
In order to process the change to your service, there will be a $50.00 Service fee (Wholesale Gateway Access Service Charge) that must be paid in full before the change can be processed.

Please type "yes" to accept the $50 Service Fee

or reset this form: