Mendocino Community Network

DSL ISP Change Form

Customers with current DSL service who wish to change ISP’s must complete this form along with an MCN order form and contract.

• The person responsible for payment of the DSL Internet service on the identified telephone number to change DSL Internet service must authorize this service, and that person must acknowledge that he/she may have existing obligations with their current ISP, but wishes to disconnect the existing DSL service and obtain DSL service from Mendocino Community Network. This form is that authorization.
• The name of the responsible person must be an exact match for the current ISP's records for service at the phone number provided below.
• Any obligations you may have with your current ISP are your responsibility. This may include early termination fees or other obligations.
• The DSL modem you own may or may not be compatible with Mendocino Community Network DSL. If this is the case, you may need to purchase additional equipment or use additional software to connect to Mendocino Community Network service
• Approx 1 day of downtime is required by SBC to make the change. You will be given the exact date of this downtime.

This form is intended as authorization for SBC/ASI to terminate DSL service with my current provider who is listed below.

Signature: ________________________________________________

Print Name: _______________________________________________