Provision Form Provision Contact InformationPhones/ExtensionsExternal NumbersPayment InformationContact InformationThanks for choosing Connex! Filling out this provision form will significantly speed up and simplify the provisioning process of your new phone service. It will provide us with the information we need to successfully install your new phones. Organization Name Primary Phone Service Address City State Zip Code First Name Last Name Mobile Phone Title Email PreviousNextPhones/ExtensionsEnter the names and extension numbers you would like to use with your new cloud phone service. You can keep your existing names and numbers that you were using with your old service. You can also create a completely new set of extension numbers. It can be something like 200, 201, 202, and so on. Then select the phone model to be used with each extension. By now, you should have the phones chosen and listed in the quote that you signed. You may pick different phones at this step if you wish, and we will revise the quote for you. Click on the + icon to add more extensions. Extension Number Name Phone Model Select phone modelT41S Desk PhoneT46S Desk PhoneT48S Desk PhoneW53P Cordless PhoneW60P Cordless PhoneCP920 Conference Phone PreviousNextPorting AuthorizationTo help us transfer your current phone number(s) to the new system, please provide us with the information below. Once we receive this information, we will initiate the porting process with your current provider and notify you about the porting completion date. As soon as the porting is completed, you will be able to use your number(s) on your new service. If you have any questions, contact us at 844-544-2258 or service@connex.netOrganization Name as it appears on the current provider bill Primary Phone Address City State Zip Code Name on the account Email Phone numbers to be portedPhone numbers that you would like to transfer to us (10 digits each, separated by comma, put FAX next to the fax number)Phone numbers to be ported Current Phone Provider InformationCurrent Phone Provider Last Four of SSN (wireless providers) Current Phone Provider Account # Pin (wireless providers) Current Internet Provider InformationCurrent Internet Provider Current Internet Provider Account # Signature I have read and agree to the Terms and Conditions By submitting this form, I authorize Connex Technologies, or its designated agent, to transfer my service and telephone number(s) from my current provider to Connex Technologies, or its designated agent. By submitting this form, I also authorize Connex Technologies, or its designated agent, to obtain billing information, customer service records, and other network information required to provide me with Connex Technologies service.PreviousNextPayment InformationThis form is an authorization for scheduled recurring charges to the account you specify. A debit transaction should appear on your statement each time your account is charged (this may vary according to your bank) for the ordered services shown on the quote/service order. Your account will not be charged until your new service is fully active. ACH Credit Card (3% fee may apply)Billing Address City State Zip Code Bank Name Name on Account Name on card Expiration date Account Number Routing Number Card number Security code I have read and agree to the Terms and Conditions By submitting this form, I authorize Connex Technologies, LLC to charge my account for the ordered services as shown on the quote/service order on or after day 1 of each month. I understand that this authorization will remain in effect until I cancel it in writing and I agree to notify Connex Technologies in writing of any changes of my payment information or request to terminate this authorization at least 15 days prior to the next billing date. In the case of a transaction being rejected for Non-Sufficient Funds, I understand that Connex Technologies may at its discretion attempt to process the charge again within 30 days. Previous Submit Form
