ProCare Membership not required for this service!

Founded in 1992, PNG Telecommunications has built a reptation as a no-nonsense carrier of telecommunications services. PNG was one of the pioneers of the "simple" flat rate pricing plans. With PNG, you will always know what you are paying without worrying about where or when you call, and we guarantee that our 3.9¢ per minute flat interstate rate will not disappear after an "introductory period". PNG bills in 6-second increments after the first 18 seconds. Intrastate rates vary by state. You can benefit today from our simplicity, quality customer service and savings!

Please print, fill out, and fax or mail this form to:

ProCare HealthPlans, Inc.
2499 Glades Road #104
Boca Raton, FL 33431
Fax (561) 750-9975

Yes! I want to save money on my long distance calls. Please change my long distance carrier to PNG Telecommunications.
PNG Direct Billed Service Agreement.

_____________________________________________________
Name (exactly as it appears on your local phone bill)

_____________________________________________________
Social Security or Federal ID Number (required)

_____________________________________________________
Billing Address (if PO Box, include installation address)

_____________________________________________________
City                                               State                 ZIP

_____________________________________________________
Billing Telephone Number

_____________________________________________________
Additional Phone Number

_____________________________________________________
Local Telephone Company

_____________________________________________________
Previous Telephone Company

_____________________________________________________
Average Monthly Long Distance Amount

[   ]	Yes, please switch my Intra LATA (Local Long Distance) to PNG. Check with your local phone company to see if this option is available.
[   ]	I would like to request a 3.9¢ per minute Toll Free number. Please have it ring to: __________________________
[   ]	I have an existing Toll Free number that I would like to switch to PNG at a 3.9¢ rate. (Must have additional Toll Free Letter of Agency)
[   ]	Yes, I would like to order ____ (quantity) PNG Telecommunications 12.9¢ per minute Calling Card(s) with no surcharge.
[   ]	Yes, please charge my credit card each month for my charges. (optional) I understand that I will still receive an itemization of my calls. Credit Card: MC ____ Visa ____ Discover ____ Amex ____ Card Number: ___________________________________ Exp. Date: ___________________________________ Signature: ___________________________________ Date: ___________________________________

For credit clearing purposes, please provide one of the following: (Business Only)

1. The cover page from your two most recent long-distance phone bills (or)

2. The Owner, President or CEO's Name:

      __________________________________________

      and Social Security Number:

      __________________________________________

Letter of Agency and Authorization for Credit Check
Terms & Conditions:

I designate PNG Telecommunications to act as my agent for selecting my primary long-distance carrier for the telephone number(s) listed above and act as my agent to my local phone company. By signing my name, I state that all preceding information is true and correct and I fully agree to the terms and conditions which are subject to local and federal laws. I hereby authorize a credit check to be performed and understand that the order is subject to credit approval. I agree to accept financial resposibility for all charges arising from the use of long-distance service, toll-free service and calling card(s). It is my responsibility to notify PNG Telecommunications of any lost or stolen calling cards. I also understand that all balances are due upon receipt and payable directly to PNG Telecommunications, and that any balances outstanding after 20 days are subject to a late charge of 1.5% per month. I understand that I am responsible for any charge(s) assesses by my local phone company for changing either my local and/or "standard" long-distance carriers. Please note that applicants who do not pass credit requirements will be notified by mail.


_____________________________________________________
AUTHORIZED SIGNATURE

_____________________________________________________
PRINT AUTHORIZED NAME

_____________________________________________________
DATE

[ Intrastate Rates ]

Back: Long Distance Savings

Print our enrollment form and send it to us with a check or credit card information
OR
call toll free @ 1-888-750-4565 from M-F 8:30 - 5:30