Customer sign up
(Name, address and telephone number MUST be entered exactly as it appears on your local telephone bill)
* Indicates required field
  Company Name (optional):
* First Name:
* Last Name:
* SSN (Social Security Number): - -
* Date of Birth (mm/dd/yyyy): / /
* Street Address:
* City :
* State :
* Zip Code :
* BTN (Billing Telephone Number): - -
* Email Address:
How did you hear about us?
Enter up to three telephone numbers other than the home phone number (such as fax, modem lines or
additional voice lines, but no cell phones or pagers
) you would like to switch over to GT TELECOMM:
  Additional phone number 1: - -
  Additional phone number 2: - -
  Additional phone number 3: - -
  Additional phone number 4: - -
  Additional phone number 5: - -
  Additional phone number 6: - -
  Additional phone number 7: - -
Yes, please switch me to GT TELECOMM long distance
      (interLATA: state-to-state & International) service.