Please provide the following contact information:

     So that you feel absolutely comfortable referring a friend, we make the following assurances:

                                                  1. Contact will be made at a respectable time                                              

             2. They will be treated with the same courtesy we extended to you.

                        Customer           Phone   

                        Acct. No. Date of Installation

                        Sales Representative

(Please print out for your records)

    Note: Referral Fee will be paid by WIDE-WORLD-ONE INC. When each new account is placed on line with 

                      our Central Station.

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