138 Mountain Brook Dr. Canton, GA 30015 Tel: (770) 345-8900 / (800) 753-1707  Fax: (770) 345-8142

PAYPHONE PROGRAMMING REQUEST

   Smart board Model: ________________________________________________

Þ Payphone’s Number: (____)_____________________________

Þ Street Address: __________________________City: ______________State: ____ Zip Code________

Þ Location Name:_____________________________________________________________________

Þ Contact Person Name: _________________________ Phone Number __________________________

Þ Your Company Name (d.b.a.) _____________________ Phone Number (____)___________________

Call Routing / Rating

Þ Pre-subscribed Operator Service Provider: ___________________________________________________

Þ Route the following long distance calls to (OSP /LXC): __________________________________________

0 +Access # _______________________________ Authorization Code ______________________________

00 + 00-Access # ___________________________ Authorization Code ______________________________

1 +Access # _______________________________ Authorization Code ______________________________

 Þ Local Calls______ ¢ for_____ minute(s) then ________ ¢ for each_______ additional Minute(s)

Incoming Calls   ON (or)   OFF [If applicable, indicate charge for incoming calls______ ¢ for____ minute(s)]

211 \ 611 Service / Repair telephone number:(_____)_______________________________

 Information Costs

Cost for 411______¢ Cost for 1-411_______¢

Cost for 555-1212 ________¢Cost for(NPA)5551212_______¢

Do you want to allow extended keypad activity for credit card calls?     Yes    No  

Programming Disclaimer

Navitel as a service for its clients, agrees to program the Paystation as designated on this 'Programming Request form’ as completed by the 'Client/Customer".  A completed 'Programming Request' form will be provided by the 'Client /Customer' to Navitel via facsimile or mail.  The 'Programming request' form must be received by Navitel prior to the remote programming required per each phone.

It is the sole responsibility of the 'Client / Customer' to provide the proper information for their Paystation) that complies with Federal and applicable state regulations and tariffs. It is the sole responsibility of the 'Customer' to secure the proper telephone line as needed to operate the Paystation, along with the applicable screening to protect against fraud and unwanted calls.

It is sole responsibility of the 'Client/Customer' to identify and provide, in writing, any changes or modifications to rate bands. This will considered by Navitel to be a special programming request subject to additional charges.

Navitel will not assume any responsibility or liability for any losses in revenue, uncollectible costs incurred or fines due to federal and or local state non-compliance that may result from programming inaccuracies caused by either Navitel and it's employees or information as supplied by the 'Client/Customer'.