New Toll-Free Number Request Form

Account Number *

Name or Business *

Contact Person *

Primary Phone Number *

Address *

Would you like vanity wording? *

• Yes
• No

If yes, please include two options for vanity wording.

Option 1

Option 2

Phone Number to Ring in on *

Blocked Area Codes (if applicable)

By typing my name below and submitting the form, I authorize Midwest Energy & Communications to provide my toll-free number as listed above. 

Full Name *

Email Address

Additional Comments