LONG DISTANCE SERVICE

Filling out the following form will grant you a free Long Distance Service quote from CBS Telecom.

1. Who is your current business long distance carrier?   AT&T Cable & Wireless Unlimited local and long distance MCI/Worldcom Qwest Sprint No current carrier Other:

2. Do you have a commitment with your current provider?   No, not committed Yes, committed for less than six months Yes, committed for more than six months

3. What types of long distance calls are most relevant to your business?   Local long distance within state Standard long distance between states International calls Not sure

4. What are your current monthly business long distance charges?   $30 - 100 per month $100 - 200 per month $200 - 400 per month $400 - 2000 per month $2,000+ per month Don't have service right now

5. How many minutes of long distance will your company use per month?   1 - 499 500 - 999 1000 - 9999 10,000 - 24,999 25,000+

6. What is your buying timeframe for business long distance service?   Right away Within a month In two or three months Between four and six months Other:

7. If interested in additional services, check all that apply.   Toll free numbers Calling cards Conference calling Other (please specify):

8. Please detail additional requirements you may have.

9. Please enter your business information. *Required *Contact Name: Contact Title: Business Name: Number of Employees: Business Address: Business City: Business State: *Business ZIP: *Phone Number: *Email Address: